Healthcare Provider Details

I. General information

NPI: 1134239395
Provider Name (Legal Business Name): ROBERT J. DOLE VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
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

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

V. Phone/Fax

Practice location:
  • Phone: 316-651-3681
  • Fax: 316-634-3075
Mailing address:
  • Phone: 316-651-3681
  • Fax: 316-634-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number3561
License Number StateKS

VIII. Authorized Official

Name: MR. PHILIP E. OLIPHANT
Title or Position: COORDINATOR
Credential: LMSW
Phone: 316-651-3681