MEDICARE: VIA CHRISTI IMMEDIATE CARE, MOTHER MARY ANNE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477692051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIA CHRISTI IMMEDIATE CARE, MOTHER MARY ANNE INC.

Provider Business Mailing Address
First Line	:	1152 S. CLIFTON
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-2913
Country	:	US
Telephone Number	:	316-689-5121
Fax Number	:	316-689-5122

Provider Business Practice Location Address
First Line	:	1152 S. CLIFTON
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-2913
Country	:	US
Telephone Number	:	316-689-5121
Fax Number	:	316-689-5122

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MS. NANCY D BETTIS
Credential	:
Telephone Number	:	316-268-5266

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/22/2010

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