| Hillside Medical Office Llc | |
|
855 N Hillside St Wichita KS 67214-4913 | |
| (316) 685-1381 | |
| Not Available |
| Full Name | Hillside Medical Office Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 855 N Hillside St, Wichita, Kansas |
| Authorized Official Name and Position | David A Gordon (MANAGER) |
| Authorized Official Contact | 3166851381 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hillside Medical Office Llc 855 N Hillside St Wichita KS 67214-4913 Ph: (316) 685-1381 | Hillside Medical Office Llc 855 N Hillside St Wichita KS 67214-4913 Ph: (316) 685-1381 |
| NPI Number | 1912969486 |
|---|---|
| Provider Enumeration Date | 04/03/2006 |
| Last Update Date | 06/18/2009 |
| Medicare PECOS PAC ID | 6709823453 |
|---|---|
| Medicare Enrollment ID | O20050413001128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912969486 | NPI | - | NPPES |
| 16399 | Other | KS | BC/BS GROUP NUMBER |
| 100087950A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Kansas) | Primary |
| Provider Name | Kimberly D Hartwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346202348 PECOS PAC ID: 8325085061 Enrollment ID: I20050413001051 |
| Provider Name | Steven D Penner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881656882 PECOS PAC ID: 7618914169 Enrollment ID: I20050415000267 |
| Provider Name | Donna L Logan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083676084 PECOS PAC ID: 2365484193 Enrollment ID: I20050523000755 |
| Provider Name | James E Logan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952363962 PECOS PAC ID: 7517909344 Enrollment ID: I20050523000780 |
| Provider Name | Hugh I Ekengren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437111994 PECOS PAC ID: 4385746908 Enrollment ID: I20100213000072 |
| Provider Name | Jason W Nugent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730334475 PECOS PAC ID: 7719002666 Enrollment ID: I20100915000475 |
| Provider Name | Bonnie E Charles Smothers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992963763 PECOS PAC ID: 1658540166 Enrollment ID: I20110817000523 |
| Provider Name | Cassie L Scripter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326210956 PECOS PAC ID: 4880864149 Enrollment ID: I20110824000876 |
| Provider Name | Laura Mayans |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245490341 PECOS PAC ID: 7113196429 Enrollment ID: I20130826000322 |
| Provider Name | Rebecca Lynn Foster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780970244 PECOS PAC ID: 0941459952 Enrollment ID: I20140618001472 |
| Provider Name | Joshua Tibbe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124347083 PECOS PAC ID: 5890949986 Enrollment ID: I20150205001162 |
| Provider Name | Bonnie C Tibbe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851737217 PECOS PAC ID: 8921233016 Enrollment ID: I20150220001505 |
| Provider Name | Stacy Ann Ignowski |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1992363311 PECOS PAC ID: 4587990239 Enrollment ID: I20230106000459 |
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