Healthcare Provider Details

I. General information

NPI: 1205919172
Provider Name (Legal Business Name): EARCARE OF CENTRAL WICHITA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S HYDRAULIC ST
WICHITA KS
67211-1908
US

IV. Provider business mailing address

303 S HYDRAULIC ST
WICHITA KS
67211-1908
US

V. Phone/Fax

Practice location:
  • Phone: 316-269-9311
  • Fax: 316-269-1444
Mailing address:
  • Phone: 316-269-9311
  • Fax: 316-269-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number7429
License Number StateKS

VIII. Authorized Official

Name: TIM BRECHEISEN
Title or Position: OWNER
Credential:
Phone: 316-269-9311