| Prairie Endoscopy Llc | |
|
12115 E 21st St N Suite 107 Wichita KS 67206-3567 | |
| (316) 440-7000 | |
| (316) 440-7006 |
| Full Name | Prairie Endoscopy Llc |
|---|---|
| Speciality | Clinic/center - Endoscopy |
| Location | 12115 E 21st St N, Wichita, Kansas |
| Authorized Official Name and Position | Jeffrey P Davis (SOLE OWNER) |
| Authorized Official Contact | 3164407000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Endoscopy Llc 12115 E 21st St N Suite 107 Wichita KS 67206-3567 Ph: (316) 440-7000 | Prairie Endoscopy Llc 12115 E 21st St N Suite 107 Wichita KS 67206-3567 Ph: (316) 440-7000 |
| NPI Number | 1699189043 |
|---|---|
| Provider Enumeration Date | 06/13/2014 |
| Last Update Date | 06/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699189043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 04-30240 (Kansas) | Secondary |
| 261QE0800X | Clinic/center - Endoscopy | 04-30240 (Kansas) | Primary |
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