1033294632 NPI number — MRS. PATRICIA GAIL LAOCHINDA PT

Table of content: MRS. PATRICIA GAIL LAOCHINDA PT (NPI 1033294632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033294632 NPI number — MRS. PATRICIA GAIL LAOCHINDA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAOCHINDA
Provider First Name:
PATRICIA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1033294632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W DOUGLAS AVE
Provider Second Line Business Mailing Address:
STE 1040
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67202-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-263-0003
Provider Business Mailing Address Fax Number:
316-263-1241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3730 N RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-440-4901
Provider Business Practice Location Address Fax Number:
316-440-4904
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  1765 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 1104385 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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