MEDICARE: UNIVERSITY OF KANSAS SCHOOL OF MEDICINE WICHITA MEDICAL PRACTICE ASSOC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208000000X	Pediatrics Physician
3	2084P0800X	Psychiatry Physician
4	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1639143712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF KANSAS SCHOOL OF MEDICINE WICHITA MEDICAL PRACTICE ASSOC

Provider Business Mailing Address
First Line	:	1010 N KANSAS
Second Line	:	STE 3049
City	:	WICHITA
State	:	KS
Zip	:	67214-3199
Country	:	US
Telephone Number	:	316-293-2620
Fax Number	:	316-293-1882

Provider Business Practice Location Address
First Line	:	1001 N MINNEAPOLIS
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3199
Country	:	US
Telephone Number	:	316-293-2620
Fax Number	:	316-293-1882

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LEWIS AARON RYAN
Credential	:	RN, MBA, FACMPE
Telephone Number	:	316-293-2620

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/04/2023

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