Provider Demographics
NPI:1881226470
Name:MOBILE DOCTORS OF KANSAS
Entity Type:Organization
Organization Name:MOBILE DOCTORS OF KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-648-1157
Mailing Address - Street 1:933 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3620
Mailing Address - Country:US
Mailing Address - Phone:316-648-1157
Mailing Address - Fax:866-316-4467
Practice Address - Street 1:933 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3620
Practice Address - Country:US
Practice Address - Phone:316-648-1157
Practice Address - Fax:866-316-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty