Provider Demographics
NPI:1174857346
Name:KANSAS PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:KANSAS PHYSICIANS GROUP, LLC
Other - Org Name:INTERNAL MEDICINE SPECIALISTS OF WICHITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OF GALICHIA HEART HOSPITAL
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-858-2601
Mailing Address - Street 1:PO BOX 47163
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7163
Mailing Address - Country:US
Mailing Address - Phone:316-462-1070
Mailing Address - Fax:316-462-1078
Practice Address - Street 1:9449 E 21ST ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2969
Practice Address - Country:US
Practice Address - Phone:316-462-1070
Practice Address - Fax:316-462-1078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALICHIA HEART HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-22
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1083693634OtherALY GADALLA, MD