Provider Demographics
NPI:1326229469
Name:PREFERRED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREFERRED MEDICAL ASSOCIATES
Other - Org Name:VCMA FAMILY MEDICINE ON WEST ST. TERESA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-268-8080
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0764
Mailing Address - Country:US
Mailing Address - Phone:316-268-8123
Mailing Address - Fax:316-291-7716
Practice Address - Street 1:14700 W SAINT TERESA ST
Practice Address - Street 2:STE. 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9603
Practice Address - Country:US
Practice Address - Phone:316-796-7970
Practice Address - Fax:316-796-7979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088910GMedicaid
016581Medicare PIN
0431660009Medicare NSC