| 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  |