Healthcare Provider Details

I. General information

NPI: 1932873759
Provider Name (Legal Business Name): ICT ANESTHESIA SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 N WEBB RD
WICHITA KS
67206-3413
US

IV. Provider business mailing address

2300 N 191ST STREET CIR W
COLWICH KS
67030-9720
US

V. Phone/Fax

Practice location:
  • Phone: 316-688-7500
  • Fax:
Mailing address:
  • Phone: 316-734-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN BERLAND
Title or Position: OWNER
Credential: CRNA
Phone: 316-734-3235