| 4 Laps Llc | |
|
7829 E Rockhill St Ste 307 Wichita KS 67206-3914 | |
| (316) 393-4574 | |
| (316) 260-1980 |
| Full Name | 4 Laps Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7829 E Rockhill St Ste 307, Wichita, Kansas |
| Authorized Official Name and Position | Reinaldo Ernesto Mijares (OWNER) |
| Authorized Official Contact | 3163934458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 4 Laps Llc 7829 E Rockhill St Ste 307 Wichita KS 67206-3914 Ph: (316) 393-4574 | 4 Laps Llc 7829 E Rockhill St Ste 307 Wichita KS 67206-3914 Ph: (316) 393-4574 |
| NPI Number | 1427749951 |
|---|---|
| Provider Enumeration Date | 05/16/2023 |
| Last Update Date | 05/16/2023 |
| Medicare PECOS PAC ID | 0749648640 |
|---|---|
| Medicare Enrollment ID | O20230626001722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427749951 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Reinaldo Ernesto Mijares |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1750490694 PECOS PAC ID: 8527002245 Enrollment ID: I20050614000764 |
| Provider Name | Lisa M Farrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871872804 PECOS PAC ID: 6800069303 Enrollment ID: I20111028000109 |
| Provider Name | Tonya J Kasselman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720367626 PECOS PAC ID: 9032382494 Enrollment ID: I20111031000196 |
| Provider Name | Jessica Mies |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386219921 PECOS PAC ID: 9931597002 Enrollment ID: I20211021001840 |
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