Provider Demographics
NPI:1396796991
Name:WICHITA MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:WICHITA MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-686-7117
Mailing Address - Street 1:347 S. LAURA ST.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1518
Mailing Address - Country:US
Mailing Address - Phone:316-686-7117
Mailing Address - Fax:316-686-2679
Practice Address - Street 1:347 S LAURA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:316-686-7117
Practice Address - Fax:316-686-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74898363LG0600X
KS44906363LG0600X, 363LG0600X
KS19204207RG0300X, 207RG0300X
KS44290363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100004190AMedicaid
KSCN3326OtherRAILROAD MEDICARE
KS016291OtherBCBS OF KANSAS
KS016291OtherBCBS OF KANSAS
KSCN3326OtherRAILROAD MEDICARE