Provider Demographics
NPI:1528024742
Name:HEALTHY OPTIONS FOR PLANEVIEW
Entity Type:Organization
Organization Name:HEALTHY OPTIONS FOR PLANEVIEW
Other - Org Name:HEALTHY OPTIONS FOR KANSAS COMMUNITIES (HOP)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-978-5637
Mailing Address - Street 1:4501 E 47TH ST S
Mailing Address - Street 2:ROOM A104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1651
Mailing Address - Country:US
Mailing Address - Phone:316-978-8011
Mailing Address - Fax:316-554-2650
Practice Address - Street 1:3620 E SUNNYBROOK LN
Practice Address - Street 2:SUITE C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1464
Practice Address - Country:US
Practice Address - Phone:316-651-5357
Practice Address - Fax:316-651-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200370570BMedicaid
KS200370570AMedicaid
KS0000421786OtherDENTAL