Healthcare Provider Details

I. General information

NPI: 1518932011
Provider Name (Legal Business Name): WICHITA EAR CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 E CENTRAL AVE
WICHITA KS
67206-2555
US

IV. Provider business mailing address

9350 E CENTRAL AVE
WICHITA KS
67206-4999
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-6608
  • Fax: 316-686-3624
Mailing address:
  • Phone: 316-686-6608
  • Fax: 316-686-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARI D BARLETT
Title or Position: BILLING
Credential:
Phone: 316-686-6608