Provider Demographics
NPI:1366548281
Name:J R HENWOOD M.D.PA
Entity type:Organization
Organization Name:J R HENWOOD M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-686-6888
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-686-6888
Mailing Address - Fax:316-686-9358
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-686-6888
Practice Address - Fax:316-686-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110473Medicare PIN