Provider Demographics
NPI:1457381170
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 1:508 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1559
Mailing Address - Country:US
Mailing Address - Phone:620-947-2396
Mailing Address - Fax:620-947-2590
Practice Address - Street 1:508 S ASH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1534
Practice Address - Country:US
Practice Address - Phone:620-947-2396
Practice Address - Fax:620-947-2590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100216070 BMedicaid
KS100216070 BMedicaid
0431660015Medicare NSC