Healthcare Provider Details

I. General information

NPI: 1790982825
Provider Name (Legal Business Name): VETRANS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
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

1830 S TARA FALLS CT
WICHITA KS
67207-6569
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2221
  • Fax:
Mailing address:
  • Phone: 316-260-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number1603295
License Number StateKS

VIII. Authorized Official

Name: MRS. NICOLE ANN SPIERS
Title or Position: RESPIRATORY THERAPIST
Credential: CRT
Phone: 316-260-3210