| Emerald Llc | |
|
9415 E Harry St Ste 503 Wichita KS 67207-5082 | |
| (316) 570-1684 | |
| Not Available |
| Full Name | Emerald Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9415 E Harry St Ste 503, Wichita, Kansas |
| Authorized Official Name and Position | George Oseko Nyakundi (OWNER) |
| Authorized Official Contact | 3169907740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerald Llc 9415 E Harry St Ste 503 Wichita KS 67207-5082 Ph: (316) 570-1684 | Emerald Llc 9415 E Harry St Ste 503 Wichita KS 67207-5082 Ph: (316) 570-1684 |
| NPI Number | 1851098065 |
|---|---|
| Provider Enumeration Date | 02/08/2023 |
| Last Update Date | 02/22/2023 |
| Certification Date | 02/22/2023 |
| Medicare PECOS PAC ID | 7517331739 |
|---|---|
| Medicare Enrollment ID | O20230329001837 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851098065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | George Oseko Nyakundi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760132369 PECOS PAC ID: 8921494238 Enrollment ID: I20220413000173 |
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