Healthcare Provider Details

I. General information

NPI: 1639253370
Provider Name (Legal Business Name): PLASTIC SURGERY CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 N WEBB RD
WICHITA KS
67206-3413
US

IV. Provider business mailing address

1861 N WEBB RD
WICHITA KS
67206-3413
US

V. Phone/Fax

Practice location:
  • Phone: 316-688-7500
  • Fax: 316-688-7543
Mailing address:
  • Phone: 316-688-7500
  • Fax: 316-688-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberS087010
License Number StateKS

VIII. Authorized Official

Name: DR. AMY SPROLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 316-688-7500