Healthcare Provider Details

I. General information

NPI: 1538195870
Provider Name (Legal Business Name): CAPSULE ENDOSCOPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N AMIDON AVE SUITE 13
WICHITA KS
67203-2100
US

IV. Provider business mailing address

PO BOX 2615
WICHITA KS
67201-2615
US

V. Phone/Fax

Practice location:
  • Phone: 877-502-1209
  • Fax: 877-219-2990
Mailing address:
  • Phone: 877-502-1209
  • Fax: 877-219-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TEVRA VENN
Title or Position: COO
Credential:
Phone: 877-502-1209