| Bon Nola, M.d. , Llc | |
|
804 S Oliver Ave Wichita KS 67218-2329 | |
| (316) 689-6004 | |
| (316) 613-2934 |
| Full Name | Bon Nola, M.d. , Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 804 S Oliver Ave, Wichita, Kansas |
| Authorized Official Name and Position | Bounsavath Nola (OWNER) |
| Authorized Official Contact | 3166896004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bon Nola, M.d. , Llc 1431 S Bluffview Dr S-116 Wichita KS 67218-3039 Ph: (316) 689-6004 | Bon Nola, M.d. , Llc 804 S Oliver Ave Wichita KS 67218-2329 Ph: (316) 689-6004 |
| NPI Number | 1275715534 |
|---|---|
| Provider Enumeration Date | 11/28/2007 |
| Last Update Date | 12/11/2023 |
| Medicare PECOS PAC ID | 0446338438 |
|---|---|
| Medicare Enrollment ID | O20080416000127 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275715534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0424718 (Kansas) | Primary |
| Provider Name | Bounsavath Nola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356336515 PECOS PAC ID: 7113912882 Enrollment ID: I20040420001037 |
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