Healthcare Provider Details

I. General information

NPI: 1912312844
Provider Name (Legal Business Name): PERRY STOUFFER RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

11819 E 47TH ST S
DERBY KS
67037-8383
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2221
  • Fax:
Mailing address:
  • Phone: 316-655-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number16-04168
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number16-04168
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number16-04168
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number16-04168
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2279P3800X
TaxonomyPalliative/Hospice Registered Respiratory Therapist
License Number16-04168
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: