Provider Demographics
NPI:1053639807
Name:PREFERRED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREFERRED MEDICAL ASSOCIATES
Other - Org Name:VCMA OB GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-268-5266
Mailing Address - Street 1:14700 W. ST. TERESA
Mailing Address - Street 2:STE. 370
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-9600
Mailing Address - Country:US
Mailing Address - Phone:316-796-7990
Mailing Address - Fax:316-796-7999
Practice Address - Street 1:14700 W. ST. TERESA
Practice Address - Street 2:STE. 370
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9600
Practice Address - Country:US
Practice Address - Phone:316-796-7990
Practice Address - Fax:316-796-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100087990EMedicaid
KS016576Medicare PIN