MEDICARE: ASCENSION VIA CHRISTI IMAGING WICHITA, LLC

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	261QR0200X	Radiology Clinic/Center		KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130622	OTHER	KS	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720099039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION VIA CHRISTI IMAGING WICHITA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 47121
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67201-7121
Country	:	US
Telephone Number	:	316-858-4091
Fax Number	:	316-369-1167

Provider Business Practice Location Address
First Line	:	2734 N WOODLAWN ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-2730
Country	:	US
Telephone Number	:	316-946-5080
Fax Number	:	316-946-5088

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CLAUDIO J FERRARO
Credential	:
Telephone Number	:	316-268-8026

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	11/01/2019

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