| Ict Internal Medicine & Pain Management, Llc | |
|
8710 W 13th St N Suite 102 Wichita KS 67212-6254 | |
| (316) 260-6363 | |
| (316) 260-6301 |
| Full Name | Ict Internal Medicine & Pain Management, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8710 W 13th St N, Wichita, Kansas |
| Authorized Official Name and Position | Angela Carlson (PRACTICE MANAGER) |
| Authorized Official Contact | 3162606363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ict Internal Medicine & Pain Management, Llc 8710 W 13th St N Suite 102 Wichita KS 67212-6254 Ph: (316) 260-6363 | Ict Internal Medicine & Pain Management, Llc 8710 W 13th St N Suite 102 Wichita KS 67212-6254 Ph: (316) 260-6363 |
| NPI Number | 1568910768 |
|---|---|
| Provider Enumeration Date | 09/15/2016 |
| Last Update Date | 03/21/2017 |
| Medicare PECOS PAC ID | 3577848266 |
|---|---|
| Medicare Enrollment ID | O20170320002430 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568910768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Baoluan T Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861682247 PECOS PAC ID: 5092881318 Enrollment ID: I20080910000082 |
| Provider Name | Kristina K Brewster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407360316 PECOS PAC ID: 6002175973 Enrollment ID: I20180123000249 |
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