Provider Demographics
NPI:1669433389
Name:MID-KANSAS PEDIATRIC ASSOCIATES, P.A.
Entity type:Organization
Organization Name:MID-KANSAS PEDIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-634-2000
Mailing Address - Street 1:9825 SHANNON WOODS
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4100
Mailing Address - Country:US
Mailing Address - Phone:316-634-2000
Mailing Address - Fax:316-634-2321
Practice Address - Street 1:9825 SHANNON WOODS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4100
Practice Address - Country:US
Practice Address - Phone:316-634-2000
Practice Address - Fax:316-634-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty