Provider Demographics
NPI:1417241902
Name:PREFERRED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREFERRED MEDICAL ASSOCIATES
Other - Org Name:VCMA MATERNAL FETAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-269-1785
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:STE. 130
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-689-5990
Mailing Address - Fax:316-689-5999
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:STE. 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-689-5990
Practice Address - Fax:316-689-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31473207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicaid
KSPENDINGMedicare PIN