Healthcare Provider Details

I. General information

NPI: 1336457548
Provider Name (Legal Business Name): VIA CHRISTI HOME MEDICAL WICHITA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 W. ST. TERESA SUITE 100
WICHITA KS
67235-9603
US

IV. Provider business mailing address

PO BOX 1933
WICHITA KS
67201-1933
US

V. Phone/Fax

Practice location:
  • Phone: 316-796-7880
  • Fax: 316-796-7884
Mailing address:
  • Phone: 316-796-7880
  • Fax: 316-796-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DEANA RAE HAYNES
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 316-858-2124