Healthcare Provider Details

I. General information

NPI: 1215516000
Provider Name (Legal Business Name): INFLAMMATORY MARKERS DIAGNOSTIC LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 E CENTRAL AVE
WICHITA KS
67206-2540
US

IV. Provider business mailing address

9412 E CENTRAL AVE
WICHITA KS
67206-2540
US

V. Phone/Fax

Practice location:
  • Phone: 316-558-5850
  • Fax: 888-494-1636
Mailing address:
  • Phone: 316-558-5850
  • Fax: 316-558-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHARLES T HINSHAW
Title or Position: LAB DIRECTOR
Credential: MD
Phone: 316-558-5850