Provider Demographics
NPI:1245564368
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. 3901
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3800
Mailing Address - Country:US
Mailing Address - Phone:316-268-8500
Mailing Address - Fax:316-291-7993
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:STE. 3901
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3800
Practice Address - Country:US
Practice Address - Phone:316-268-8500
Practice Address - Fax:316-291-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44097363L00000X
KS04-344352084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100723300CMedicaid
KS100087990DMedicaid
KSKA1517Medicare PIN