Healthcare Provider Details

I. General information

NPI: 1831423888
Provider Name (Legal Business Name): CENTER FOR WOMENS HEALTH OF WICHITA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 E 21ST ST N SUITE 301
WICHITA KS
67206-3508
US

IV. Provider business mailing address

10111 E 21ST ST N SUITE 301
WICHITA KS
67206-3508
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-0060
  • Fax:
Mailing address:
  • Phone: 316-634-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN BREIT
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 316-634-0060