1518932011 NPI number — WICHITA EAR CLINIC, PA

Table of content: (NPI 1518932011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518932011 NPI number — WICHITA EAR CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WICHITA EAR CLINIC, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518932011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9350 E CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67206-4999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-686-6608
Provider Business Mailing Address Fax Number:
316-686-3624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9350 E CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67206-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-686-6608
Provider Business Practice Location Address Fax Number:
316-686-3624
Provider Enumeration Date:
02/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARLETT
Authorized Official First Name:
CARI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
316-686-6608

Provider Taxonomy Codes

  • Taxonomy code: 207YX0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110245 . This is a "BLUE CROSS/BLUE SHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 3257 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CD7286 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".