Provider Demographics
NPI:1295002582
Name:IBRACE MEDICAL
Entity type:Organization
Organization Name:IBRACE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-580-8038
Mailing Address - Street 1:4515 E CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3915
Mailing Address - Country:US
Mailing Address - Phone:501-580-8038
Mailing Address - Fax:
Practice Address - Street 1:1028 N CREST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-7204
Practice Address - Country:US
Practice Address - Phone:501-580-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies