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General NPI Number Information
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NPI Number | 1669611778
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Entity Type | Organization
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Legal Business Name | WICHITA DIAGNOSTIC PARTNERS, PLLC
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 639 N 13TH ST
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City | CORSICANA
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State | TX
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Zip | 75110-3015
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Country | US
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Telephone | 866-654-9911
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Fax |
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Provider Business Mailing Address
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Address Line | 639 N 13TH ST
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City | CORSICANA
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State | TX
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Zip | 75110-3015
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Country | US
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Telephone | 866-654-9911
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KAMERON SMITH
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Credential |
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Telephone | 866-654-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State | TX
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