Provider Demographics
NPI:1558141747
Name:DEDICATED PHYSICIANS GROUP OF KANSAS LLC
Entity Type:Organization
Organization Name:DEDICATED PHYSICIANS GROUP OF KANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-628-6117
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:961 S GLENDALE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3210
Practice Address - Country:US
Practice Address - Phone:316-618-9555
Practice Address - Fax:316-400-6513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDICATED PHYSICIANS GROUP OF KANSAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site