Provider Demographics
NPI:1598097800
Name:ADVANCED MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES, P.A.
Other - Org Name:KANSAS P.T. & SPINE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-613-2953
Mailing Address - Street 1:150 S ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1152
Mailing Address - Country:US
Mailing Address - Phone:316-613-2953
Mailing Address - Fax:316-684-2225
Practice Address - Street 1:8100 E 22ND ST N BLDG 2200-4
Practice Address - Street 2:TALLGRASS EXECUTIVE OFFICE PARK
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-201-6445
Practice Address - Fax:316-684-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103452225100000X
KS1103536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1244000002Medicare NSC
KS110298Medicare PIN