Provider Demographics
NPI:1942380100
Name:MEDICAL CONSULTANTS OF PITTSBURG, INC.
Entity Type:Organization
Organization Name:MEDICAL CONSULTANTS OF PITTSBURG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-3000
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-1023
Mailing Address - Country:US
Mailing Address - Phone:620-231-8849
Mailing Address - Fax:620-231-8847
Practice Address - Street 1:608 WILLARD
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:KS
Practice Address - Zip Code:66763-2120
Practice Address - Country:US
Practice Address - Phone:620-231-8849
Practice Address - Fax:620-231-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25406207R00000X
KS45744363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110994OtherMEDICARE
KSDA9115OtherGRP RR MEDICARE
KS110994OtherGROUP BCBS