Provider Demographics
NPI:1982884268
Name:PREFERRED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREFERRED MEDICAL ASSOCIATES
Other - Org Name:VCMA PULMO
Other - Org Type:Doing Business As
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:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0764
Mailing Address - Country:US
Mailing Address - Phone:316-261-3141
Mailing Address - Fax:316-261-3202
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:STE 1962
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3800
Practice Address - Country:US
Practice Address - Phone:316-261-3141
Practice Address - Fax:316-261-3202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088910QMedicaid
0431660020Medicare NSC
111098Medicare PIN