| Spectrum Family Medical Clinic, Pa | |
|
2020 N Tyler Ste 114 Wichita KS 67212-4916 | |
| (316) 462-0460 | |
| (316) 462-0465 |
| Full Name | Spectrum Family Medical Clinic, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2020 N Tyler, Wichita, Kansas |
| Authorized Official Name and Position | Phaedra M Mann (OFFICE MANAGER) |
| Authorized Official Contact | 3164620460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Family Medical Clinic, Pa 2020 N Tyler Ste 114 Wichita KS 67212-4916 Ph: () - | Spectrum Family Medical Clinic, Pa 2020 N Tyler Ste 114 Wichita KS 67212-4916 Ph: (316) 462-0460 |
| NPI Number | 1912963067 |
|---|---|
| Provider Enumeration Date | 04/25/2006 |
| Last Update Date | 10/05/2017 |
| Medicare PECOS PAC ID | 7012066228 |
|---|---|
| Medicare Enrollment ID | O20090519000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912963067 | NPI | - | NPPES |
| 100112800C | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0422366 (Kansas) | Primary |
| Provider Name | Joseph M Sack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962475343 PECOS PAC ID: 1850440058 Enrollment ID: I20090519000101 |
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