Organization Active NPI

Podiatry Clinic, P.a.

  • Podiatrist
  • Wichita, KS
National Provider Identifier
1043419625
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
12-00142 Issued in KS
Legal business name
PODIATRY CLINIC, P.A.
Practice address
400 N Woodlawn St Ste 211
Wichita, KS 67208-4332
Phone
(316) 685-3801
Fax
(316) 685-6901
NPI assigned
Jul 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Larry K McNeil, D.P.M.
Title
President
Phone
(316) 685-3801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 12-00142 KS Primary

Addresses

Primary practice location

400 N Woodlawn St Ste 211
Wichita, KS 67208-4332

Mailing address

400 N Woodlawn St Ste 211
Wichita, KS 67208-4332
Phone (316) 685-3801

Other identifiers 2

IdentifierTypeStateIssuer
480029429OtherKSRRMEDICARE
100094390BMedicaidKS

National Provider Directory

National Provider Directory

Locations

640 N Osage St
Augusta, KS 67010
Phone (316) 775-1189

400 N Woodlawn St
Ste 211
Wichita, KS 67208
Phone (316) 685-3801

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1043419625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N WOODLAWN ST STE 211",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672084332",
            "telephone_number": "316-685-3801",
            "fax_number": "316-685-6901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N WOODLAWN ST STE 211",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672084332",
            "telephone_number": "316-685-3801",
            "fax_number": "316-685-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "MCNEIL",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "316-685-3801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "KS",
            "license": "12-00142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE",
            "identifier": "480029429",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100094390B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.