Provider Demographics
NPI:1205061017
Name:PREFERRED MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:PREFERRED MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-268-8080
Mailing Address - Street 1:848 N SAINT FRANCIS ST
Mailing Address - Street 2:STE. 3949
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3800
Mailing Address - Country:US
Mailing Address - Phone:316-268-8040
Mailing Address - Fax:316-291-4880
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:STE. 3949
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3800
Practice Address - Country:US
Practice Address - Phone:316-268-8040
Practice Address - Fax:316-291-4880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100723300DMedicaid
KSPENDINGMedicaid
KSKA1517Medicare PIN