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9449 E 21st St N Ste 200 Wichita KS 67206-2970 | |
| (316) 866-2905 | |
| (316) 558-8392 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 9449 E 21st St N Ste 200, Wichita, Kansas |
| Authorized Official Name and Position | Monica Melean (OFFICE MANAGER) |
| Authorized Official Contact | 3168662905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
9449 E 21st St N Ste 200 Wichita KS 67206-2970 Ph: () - | 9449 E 21st St N Ste 200 Wichita KS 67206-2970 Ph: (316) 866-2905 |
| NPI Number | 1861576886 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1254332943 |
|---|---|
| Medicare Enrollment ID | O20070123000642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861576886 | NPI | - | NPPES |
| 111220 | Other | KS | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Patricia A Bledsoe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952325524 PECOS PAC ID: 1456357417 Enrollment ID: I20061013000488 |
| Provider Name | Scott A Bledsoe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598711228 PECOS PAC ID: 0547311714 Enrollment ID: I20090629000313 |
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