Provider Demographics
NPI:1497126585
Name:MARIA MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:MARIA MEDICAL SERVICES LLC
Other - Org Name:MED-PED CLINIC OF WICHITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:316-440-2712
Mailing Address - Street 1:9415 E HARRY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5076
Mailing Address - Country:US
Mailing Address - Phone:316-691-0309
Mailing Address - Fax:316-691-0881
Practice Address - Street 1:9415 E HARRY ST STE 202
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5076
Practice Address - Country:US
Practice Address - Phone:316-691-0309
Practice Address - Fax:316-691-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty