Healthcare Provider Details
I. General information
NPI: 1730413196
Provider Name (Legal Business Name): VIA CHRISTI REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
707 N EMPORIA ST
WICHITA KS
67214-3707
US
IV. Provider business mailing address
PO BOX 1897
WICHITA KS
67201-1897
US
V. Phone/Fax
- Phone: 316-858-3470
- Fax: 316-291-4788
- Phone: 316-268-8131
- Fax: 316-291-4788
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RS0010X |
| Taxonomy | Sports Medicine (Internal Medicine) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MICHALENE
D
MARINGER
Title or Position: PRESIDENT VCRMC & CEO
Credential:
Phone: 316-268-5108