=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063453991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCENSION MEDICAL GROUP VIA CHRISTI, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 06/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3311 E MURDOCK ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-689-9135
-----------------------------------------------------
Fax | 316-689-9102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2969
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67201-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-268-5178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR,PATIENT FINANCIAL SERVICES
-----------------------------------------------------
Name | SUZANN M WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-719-1201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------