1073523452 NPI number — ASCENSION MEDICAL GROUP VIA CHRISTI, PA

Table of content: (NPI 1073523452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073523452 NPI number — ASCENSION MEDICAL GROUP VIA CHRISTI, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION MEDICAL GROUP VIA CHRISTI, 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:
VIA CHRISTI CLINIC SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1073523452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8035
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:
67208-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-689-9135
Provider Business Mailing Address Fax Number:
316-689-9102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1947 N FOUNDERS ST
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:
67206-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-613-4931
Provider Business Practice Location Address Fax Number:
316-613-4937
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
SUZANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR,PATIENT FINANCIAL SERVICES
Authorized Official Telephone Number:
316-719-1201

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  S087015 , 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)

  • Identifier: 245716 . This is a "COVENTRY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CC8848 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00294493 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 101103 . This is a "HPK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 112223 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 14908 . This is a "PHS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CU0056 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200726520H , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC8849 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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