Healthcare Provider Details

I. General information

NPI: 1760773048
Provider Name (Legal Business Name): JOHN W ORMISTON LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 E 22ND ST N BLDG 2300-3
WICHITA KS
67226-2306
US

IV. Provider business mailing address

650 N LANCASTER DR
WICHITA KS
67230-6608
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7525
  • Fax: 316-660-7510
Mailing address:
  • Phone: 316-272-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7902
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4528
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: