Basic Information
| Provider Information | |||||||||
| NPI: | 1861401028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THORNHILL-SCOTT | ||||||||
| FirstName: | FANNETTE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 N. HILLSIDE | ||||||||
| Address2: | BUILDING 1, 6TH FL | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169627422 | ||||||||
| FaxNumber: | 3169627805 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 N HILLSIDE ST | ||||||||
| Address2: | BUILDING 1, 6TH FL | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672144910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169627422 | ||||||||
| FaxNumber: | 3169627805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 30201 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 100452250A | 05 | KS | MEDICAID | 6490 | 01 | KS | PHS | OTHER | 102815 | 01 | KS | BCBS | OTHER | 103699 | 01 | KS | HPK | OTHER | 138700 | 01 | KS | COVENTRY | OTHER | 12149413 | 01 | KS | MULTIPLAN | OTHER |