| Mobile Medical, Llc | |
|
345 N Riverview St Ste 500 Wichita KS 67203-4265 | |
| (316) 616-1055 | |
| (855) 633-0585 |
| Full Name | Mobile Medical, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 345 N Riverview St Ste 500, Wichita, Kansas |
| Authorized Official Name and Position | Brent Sanders (CEO) |
| Authorized Official Contact | 3166161055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Medical, Llc 101 W Hefner Rd Oklahoma City OK 73114-6631 Ph: (316) 616-1055 | Mobile Medical, Llc 345 N Riverview St Ste 500 Wichita KS 67203-4265 Ph: (316) 616-1055 |
| NPI Number | 1366727463 |
|---|---|
| Provider Enumeration Date | 10/20/2011 |
| Last Update Date | 06/29/2024 |
| Medicare PECOS PAC ID | 9335316066 |
|---|---|
| Medicare Enrollment ID | O20120120000825 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366727463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (Kansas) | Secondary |
| Provider Name | Susan Giovanni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689616203 PECOS PAC ID: 4183676091 Enrollment ID: I20050218000154 |
| Provider Name | Veomany Dang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578708699 PECOS PAC ID: 7012055148 Enrollment ID: I20091111000139 |
| Provider Name | Tiffany Ann Welk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730109554 PECOS PAC ID: 9830229830 Enrollment ID: I20100618000295 |
| Provider Name | Kristin M Harter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265781074 PECOS PAC ID: 6608028543 Enrollment ID: I20121128000738 |
| Provider Name | Christy Marie Tennissen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063801157 PECOS PAC ID: 3072697481 Enrollment ID: I20150306001284 |
| Provider Name | Heidi Marie Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821651167 PECOS PAC ID: 3072842962 Enrollment ID: I20190830001745 |
| Provider Name | Amber Raelynn Neighbors |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457934267 PECOS PAC ID: 7214336106 Enrollment ID: I20210526000811 |
| Provider Name | Micha Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851903868 PECOS PAC ID: 5395144885 Enrollment ID: I20210603002222 |
| Provider Name | Larreasha Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811505803 PECOS PAC ID: 6204253958 Enrollment ID: I20210826002231 |
| Provider Name | Kristin J Watts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376965723 PECOS PAC ID: 8123434255 Enrollment ID: I20210907001910 |
| Provider Name | Stacey Lynn Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396320958 PECOS PAC ID: 0042608929 Enrollment ID: I20211026001687 |
| Provider Name | Julie M O'gara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487252193 PECOS PAC ID: 7012300643 Enrollment ID: I20220203000975 |
| Provider Name | Manuel Brockman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588152607 PECOS PAC ID: 4284982893 Enrollment ID: I20220825003958 |
| Provider Name | Latonia Howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891278743 PECOS PAC ID: 7810399458 Enrollment ID: I20231211000215 |
| Provider Name | Karen Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205691052 PECOS PAC ID: 0143666503 Enrollment ID: I20240308000362 |
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