Provider Demographics
NPI:1750835146
Name:MARIA REGINA OBSTETRICS AND GYNECOLOGY LLC
Entity Type:Organization
Organization Name:MARIA REGINA OBSTETRICS AND GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-320-0501
Mailing Address - Street 1:700 W CENTRAL AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-320-0501
Mailing Address - Fax:316-321-0503
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-320-0501
Practice Address - Fax:316-321-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0539129207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty