Healthcare Provider Details

I. General information

NPI: 1922396894
Provider Name (Legal Business Name): JOSEPH MEOUCHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N EMPORIA ST STE 310
WICHITA KS
67214-3727
US

IV. Provider business mailing address

818 N EMPORIA ST STE 310
WICHITA KS
67214-3727
US

V. Phone/Fax

Practice location:
  • Phone: 316-263-5891
  • Fax: 316-263-3083
Mailing address:
  • Phone: 316-263-5891
  • Fax: 316-263-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number04-40337
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: