Healthcare Provider Details

I. General information

NPI: 1710181177
Provider Name (Legal Business Name): DR. RICK LEE HARTWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 W HARBORLIGHT ST
WICHITA KS
67204-2574
US

IV. Provider business mailing address

1821 W HARBORLIGHT ST
WICHITA KS
67204-2574
US

V. Phone/Fax

Practice location:
  • Phone: 316-832-1250
  • Fax: 316-832-1250
Mailing address:
  • Phone: 316-832-1250
  • Fax: 316-832-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number0420015
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: