Provider Demographics
NPI:1700650355
Name:MALC GROUP HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MALC GROUP HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMBUGU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:816-726-3686
Mailing Address - Street 1:4045 W 147TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3825
Mailing Address - Country:US
Mailing Address - Phone:816-726-3686
Mailing Address - Fax:
Practice Address - Street 1:5251 W 116TH PL STE 200
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-2011
Practice Address - Country:US
Practice Address - Phone:913-420-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty