Healthcare Provider Details

I. General information

NPI: 1336420793
Provider Name (Legal Business Name): NEWMAN UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MCCORMICK ST
WICHITA KS
67213-2008
US

IV. Provider business mailing address

3100 W MCCORMICK AVE
WICHITA KS
67213-2008
US

V. Phone/Fax

Practice location:
  • Phone: 316-942-4291
  • Fax:
Mailing address:
  • Phone: 316-942-4291
  • Fax: 316-942-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CAM CLARK
Title or Position: ATHLETIC DIRECTOR
Credential:
Phone: 316-942-4291