Provider Demographics
NPI:1407886120
Name:WICHITA OB-GYN ASSOCIATES, PA
Entity Type:Organization
Organization Name:WICHITA OB-GYN ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:316-685-0559
Mailing Address - Street 1:PO BOX 3951
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3951
Mailing Address - Country:US
Mailing Address - Phone:316-685-0559
Mailing Address - Fax:316-685-0455
Practice Address - Street 1:551 N HILLSIDE ST
Practice Address - Street 2:STE 510
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4923
Practice Address - Country:US
Practice Address - Phone:316-685-0559
Practice Address - Fax:316-685-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200741040AMedicaid
KSKA2435Medicare PIN
0431660018Medicare NSC