| Kansas Mobile Healthcare Llc | |
|
14748 Sw 230th St Douglass KS 67039-8127 | |
| (316) 323-1400 | |
| (316) 323-1402 |
| Full Name | Kansas Mobile Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14748 Sw 230th St, Douglass, Kansas |
| Authorized Official Name and Position | Micha Webb (PARTIAL OWNER) |
| Authorized Official Contact | 3162497715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kansas Mobile Healthcare Llc 14748 Sw 230th St Douglass KS 67039-8127 Ph: (316) 323-1400 | Kansas Mobile Healthcare Llc 14748 Sw 230th St Douglass KS 67039-8127 Ph: (316) 323-1400 |
| NPI Number | 1215749189 |
|---|---|
| Provider Enumeration Date | 01/27/2025 |
| Last Update Date | 02/18/2025 |
| Medicare PECOS PAC ID | 1557887809 |
|---|---|
| Medicare Enrollment ID | O20250429002795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215749189 | NPI | - | NPPES |
| 1063801157 | Medicaid | KS | |
| 1669498010 | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Christy Marie Tennissen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063801157 PECOS PAC ID: 3072697481 Enrollment ID: I20150306001284 |
| Provider Name | Micha Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851903868 PECOS PAC ID: 5395144885 Enrollment ID: I20210603002222 |