Provider Demographics
NPI:1417191024
Name:ALLENBACH, RICHARD G (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:ALLENBACH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N SAINT FRANCIS ST
Mailing Address - Street 2:HEART VALVE CLINIC
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3821
Mailing Address - Country:US
Mailing Address - Phone:316-268-8650
Mailing Address - Fax:316-268-8598
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:HEART VALVE CLINIC
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-8650
Practice Address - Fax:316-268-8598
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00394363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200879170CMedicaid
OK200496810AMedicaid
OK200496810AMedicaid