Provider Demographics
NPI:1871777151
Name:EVA HENRY, P.A.
Entity type:Organization
Organization Name:EVA HENRY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:LAI
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-558-2788
Mailing Address - Street 1:13315 E TALLOWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-1709
Mailing Address - Country:US
Mailing Address - Phone:316-558-2788
Mailing Address - Fax:316-260-5424
Practice Address - Street 1:10111 E 21ST ST N
Practice Address - Street 2:STE #105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3508
Practice Address - Country:US
Practice Address - Phone:316-260-5001
Practice Address - Fax:316-260-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-22
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31204204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105080Medicare PIN