Provider Demographics
NPI:1437443488
Name:ADVANCED MOBILE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ADVANCED MOBILE HEALTHCARE, LLC
Other - Org Name:PHYSICIAN HOUSE CALLS OF KANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:MELUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-312-0002
Mailing Address - Street 1:3450 N ROCK RD STE 503
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1355
Mailing Address - Country:US
Mailing Address - Phone:316-312-0002
Mailing Address - Fax:316-854-5644
Practice Address - Street 1:3450 N ROCK RD STE 503
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1355
Practice Address - Country:US
Practice Address - Phone:316-312-0002
Practice Address - Fax:316-854-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-32303207Q00000X
KS53-76590363LA2200X
KS45062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201104060BMedicaid
KS100229520CMedicaid
KS200769120AMedicaid