Healthcare Provider Details

I. General information

NPI: 1669498010
Provider Name (Legal Business Name): JASON A HAMPL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N WOODLAWN BLVD
WICHITA KS
67220-2729
US

IV. Provider business mailing address

2600 N WOODLAWN BLVD
WICHITA KS
67220-2729
US

V. Phone/Fax

Practice location:
  • Phone: 316-684-3838
  • Fax: 316-858-2527
Mailing address:
  • Phone: 316-684-3838
  • Fax: 316-858-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0431029
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number431029
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: