Healthcare Provider Details

I. General information

NPI: 1952405409
Provider Name (Legal Business Name): VIA CHRISTI CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 N FOUNDERS ST
WICHITA KS
67206-3548
US

IV. Provider business mailing address

PO BOX 8035
WICHITA KS
67208-0035
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-4625
  • Fax: 316-689-9313
Mailing address:
  • Phone: 316-689-9135
  • Fax: 316-689-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SUZANN M WRIGHT
Title or Position: DIRECTOR, PATIENT FINANCIAL SERVICE
Credential:
Phone: 316-689-9617