| Wichita Primary Care Llc | |
|
2230 N Ridge Rd Wichita KS 67205-1053 | |
| (316) 448-8339 | |
| (316) 221-7149 |
| Full Name | Wichita Primary Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2230 N Ridge Rd, Wichita, Kansas |
| Authorized Official Name and Position | Heidi Larison (OWNER) |
| Authorized Official Contact | 3164488339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wichita Primary Care Llc 2230 N Ridge Rd Wichita KS 67205-1053 Ph: (316) 448-8339 | Wichita Primary Care Llc 2230 N Ridge Rd Wichita KS 67205-1053 Ph: (316) 448-8339 |
| NPI Number | 1164908281 |
|---|---|
| Provider Enumeration Date | 07/11/2018 |
| Last Update Date | 01/25/2021 |
| Certification Date | 01/25/2021 |
| Medicare PECOS PAC ID | 7911243316 |
|---|---|
| Medicare Enrollment ID | O20190104002967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164908281 | NPI | - | NPPES |
| Provider Name | Heidi D Larison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447455662 PECOS PAC ID: 1153454749 Enrollment ID: I20100803000840 |
| Provider Name | Sylvia M Woodard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063898823 PECOS PAC ID: 8426358441 Enrollment ID: I20151124001181 |
| Provider Name | Brian J Kowal |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194380477 PECOS PAC ID: 7911232475 Enrollment ID: I20190706000114 |
| Provider Name | Molly A Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417359373 PECOS PAC ID: 4284962911 Enrollment ID: I20190820001046 |
| Provider Name | Madison Osburn |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1427681428 PECOS PAC ID: 9032531652 Enrollment ID: I20200626000973 |
| Provider Name | Michele Keethler |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1538776422 PECOS PAC ID: 1759761323 Enrollment ID: I20220629002665 |
| Provider Name | Shana Cables |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1013564020 PECOS PAC ID: 3678953676 Enrollment ID: I20220708000601 |
| Provider Name | Miranda Abigail Bradfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902545809 PECOS PAC ID: 7810344256 Enrollment ID: I20231107002783 |
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