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3701 E 13th St N Wichita KS 67208-2086 | |
| (316) 866-2000 | |
| (316) 866-2084 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3701 E 13th St N, Wichita, Kansas |
| Authorized Official Name and Position | Venus Lee (CEO) |
| Authorized Official Contact | 3168662064 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1122 N Topeka St Wichita KS 67214-2810 Ph: (316) 866-2000 | 3701 E 13th St N Wichita KS 67208-2086 Ph: (316) 866-2000 |
| NPI Number | 1659631695 |
|---|---|
| Provider Enumeration Date | 05/24/2012 |
| Last Update Date | 02/01/2022 |
| Medicare PECOS PAC ID | 9830098185 |
|---|---|
| Medicare Enrollment ID | O20101115000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659631695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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