MEDICARE: MOTHER'S TOUCH MOBILE PHYSICIANS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1104361963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHER'S TOUCH MOBILE PHYSICIANS, INC.

Provider Business Mailing Address
First Line	:	319 N DOWELL ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2789
Country	:	US
Telephone Number	:	316-682-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 N DOWELL ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2789
Country	:	US
Telephone Number	:	316-682-1232
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKE NICHOLAS
Credential	:	RN
Telephone Number	:	316-682-1232

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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