Provider Demographics
NPI:1124083308
Name:LINE MEDICAL INC
Entity type:Organization
Organization Name:LINE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-262-3444
Mailing Address - Street 1:PO BOX 3172
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3172
Mailing Address - Country:US
Mailing Address - Phone:316-262-3444
Mailing Address - Fax:316-262-3006
Practice Address - Street 1:750 AVENUE D WEST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068
Practice Address - Country:US
Practice Address - Phone:316-262-3444
Practice Address - Fax:316-262-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100279560AMedicaid
KS110303OtherBCBS
KS110303Medicare PIN