1295821858 NPI number — WICHITA STATE UNIVERSITY

Table of content: (NPI 1295821858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295821858 NPI number — WICHITA STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WICHITA STATE UNIVERSITY
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:
6
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:
1295821858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1845 FAIRMOUNT ST
Provider Second Line Business Mailing Address:
CAMPUS BOX 99
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67260-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-978-3289
Provider Business Mailing Address Fax Number:
316-978-7264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5015 E 29TH STN
Provider Second Line Business Practice Location Address:
DOOR T
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67220-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-978-3289
Provider Business Practice Location Address Fax Number:
316-978-7264
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VIZZINI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROVOST AND SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
316-978-3010

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200004590A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100345290C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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