Healthcare Provider Details

I. General information

NPI: 1982866034
Provider Name (Legal Business Name): EARCARE NORTHWEST WICHITA OUTREACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8606 W 13TH ST N STE 160
WICHITA KS
67212-6208
US

IV. Provider business mailing address

8606 W 13TH ST N STE 160
WICHITA KS
67212-6208
US

V. Phone/Fax

Practice location:
  • Phone: 316-721-4138
  • Fax:
Mailing address:
  • Phone: 316-721-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberCE569
License Number StateKS

VIII. Authorized Official

Name: TIM BRECHEISEN
Title or Position: OWNER
Credential:
Phone: 316-269-4327