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PEARL OBGYN LLC NPI 1659949931


NPI Information

NPI: 1659949931
Provider Name: PEARL OBGYN LLC
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 17D2288467

Address:
3252 E DOUGLAS AVE STE 101
WICHITA, KS
ZIP 67208
Phone: (316) 687-3275
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PEARL OBGYN LLC is an obstetrics gynecology in Wichita, KS. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. PEARL OBGYN LLC NPI is 1659949931. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3252 E DOUGLAS AVE STE 101
WICHITA, KS
ZIP 67208-354
Phone: (316) 687-3275
Fax: (316) 469-5222

The provider's authorized official is Damen Hershberger .
The authorized official title is Owner and has the following contact phone number (316) 687-3275.

The CLIA number assigned to this NPI record is 17D2288467 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/14/2021 and was last updated on 7/28/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1PENDINGMEDICAIDKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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