| Medical On Demand Llc | |
|
10346 E Stonegate Ln Ste 100 Wichita KS 67206-2054 | |
| (316) 871-0995 | |
| Not Available |
| Full Name | Medical On Demand Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 10346 E Stonegate Ln Ste 100, Wichita, Kansas |
| Authorized Official Name and Position | Justin Gooden (OWNER) |
| Authorized Official Contact | 3168710995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical On Demand Llc 326 N Wabash Ave Wichita KS 67214-3948 Ph: (316) 871-0995 | Medical On Demand Llc 10346 E Stonegate Ln Ste 100 Wichita KS 67206-2054 Ph: (316) 871-0995 |
| NPI Number | 1518618958 |
|---|---|
| Provider Enumeration Date | 01/18/2022 |
| Last Update Date | 05/21/2025 |
| Medicare PECOS PAC ID | 3476936865 |
|---|---|
| Medicare Enrollment ID | O20220817003292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518618958 | NPI | - | NPPES |
| 200556580D | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Abbie Lou Collinsworth |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902996630 PECOS PAC ID: 9931176153 Enrollment ID: I20040915001144 |
| Provider Name | Lynnette M Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689869505 PECOS PAC ID: 1254427735 Enrollment ID: I20071013000120 |
| Provider Name | Megan C Hawks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215136478 PECOS PAC ID: 0042345472 Enrollment ID: I20100324000149 |
| Provider Name | Justin Lee Gooden |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205127982 PECOS PAC ID: 7911153382 Enrollment ID: I20140408002138 |
| Provider Name | Trisha Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760093983 PECOS PAC ID: 5395162267 Enrollment ID: I20200825000308 |
| Provider Name | Taylor Berner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376132324 PECOS PAC ID: 4284040007 Enrollment ID: I20210302003034 |
| Provider Name | Megan Marie Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801462825 PECOS PAC ID: 0648669457 Enrollment ID: I20211117001640 |
| Provider Name | Danielle Renee Villanueva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124617972 PECOS PAC ID: 5799174470 Enrollment ID: I20211118001603 |
| Provider Name | Amber Michelle Kamalei Sudduth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871217018 PECOS PAC ID: 6305222803 Enrollment ID: I20221006003060 |
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