Provider Demographics
NPI:1164529368
Name:RONALD C FERRIS MD
Entity Type:Organization
Organization Name:RONALD C FERRIS MD
Other - Org Name:HOLY FAMILY MEDICAL ASSOCIATES LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-682-9900
Mailing Address - Street 1:144 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2154
Mailing Address - Country:US
Mailing Address - Phone:316-682-9900
Mailing Address - Fax:316-682-0311
Practice Address - Street 1:144 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2154
Practice Address - Country:US
Practice Address - Phone:316-682-9900
Practice Address - Fax:316-682-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27664207Q00000X
KST02828363A00000X
KS46056363L00000X
KS46255363L00000X
KS104077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111035OtherBCBS
KS200362010AMedicaid
KS200362010AMedicaid