Active NPI
Ohaebosim Medical Clinic Inc
- Family Medicine Physician
- Wichita, KS
National Provider Identifier
1497829261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0516911
- Legal business name
- OHAEBOSIM MEDICAL CLINIC INC
- Practice address
- 2810 E 21St Street
Wichita, KS 67214-2252 - Phone
- (316) 681-1901
- Fax
- (316) 618-7362
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Linus C Ohaebosim, DO
- Title
- Owner President
- Phone
- (316) 681-1901
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0516911 | KS | Primary |
Addresses
Primary practice location
2810 E 21St Street
Wichita, KS 67214-2252
Mailing address
2810 E 21St Street
Wichita, KS 67214-2252
Phone (316) 681-1901
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 614790 | Other | FIRST GUARD | |
| 693 | Other | KS | PHS |
| 49202 | Other | KS | BLUE SHIELD |
| 4083832 | Other | AETNA | |
| 100098690A | Medicaid | KS |
National Provider Directory
National Provider DirectoryLocations
2810 E 21st St N
Wichita, KS 67214
Phone (316) 681-1901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1324425600000",
"number": "1497829261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 E 21ST STREET",
"city": "WICHITA",
"state": "KS",
"postal_code": "672142252",
"telephone_number": "316-681-1901",
"fax_number": "316-618-7362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2810 E 21ST STREET",
"city": "WICHITA",
"state": "KS",
"postal_code": "672142252",
"telephone_number": "316-681-1901",
"fax_number": "316-618-7362"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OHAEBOSIM MEDICAL CLINIC INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-20",
"last_updated": "2011-12-21",
"status": "A",
"authorized_official_last_name": "OHAEBOSIM",
"authorized_official_first_name": "LINUS",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER PRESIDENT",
"authorized_official_telephone_number": "316-681-1901",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "KS",
"license": "0516911",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST GUARD",
"identifier": "614790",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHS",
"identifier": "693",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "49202",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4083832",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100098690A",
"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 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.