Provider Demographics
NPI:1215659156
Name:HOLY FAMILY MEDICAL, INC.
Entity type:Organization
Organization Name:HOLY FAMILY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-682-9900
Mailing Address - Street 1:144 S. HILLSIDE ST.
Mailing Address - Street 2:WICHITA, KS 67211
Mailing Address - City:WICHITA, KS
Mailing Address - State:KS
Mailing Address - Zip Code:67211
Mailing Address - Country:US
Mailing Address - Phone:316-682-9900
Mailing Address - Fax:316-682-0311
Practice Address - Street 1:144 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2154
Practice Address - Country:US
Practice Address - Phone:316-682-9900
Practice Address - Fax:316-682-9900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY FAMILY MEDICAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicaid