Healthcare Provider Details

I. General information

NPI: 1962270017
Provider Name (Legal Business Name): JAMES MITCHELL HEWITT LAT, ATC, CES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E SWENSSON AVE
LINDSBORG KS
67456-1817
US

IV. Provider business mailing address

1044 N PERRY AVE
WICHITA KS
67203-3021
US

V. Phone/Fax

Practice location:
  • Phone: 316-347-5661
  • Fax:
Mailing address:
  • Phone: 316-347-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number24-01404
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: