Basic Information
| Provider Information | |||||||||
| NPI: | 1063453991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION MEDICAL GROUP VIA CHRISTI, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2969 | ||||||||
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| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672012969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162685178 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3311 E MURDOCK ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166899135 | ||||||||
| FaxNumber: | 3166899102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | SUZANN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR,PATIENT FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 3167191201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | CC8489 | 01 | KS | MEDICARE RAILROAD | OTHER | 003719 | 01 | KS | BCBS | OTHER | CC8488 | 01 | KS | MEDICARE RAILROAD | OTHER | 100080310A | 05 | KS | MEDICAID | 200726520I | 05 | KS | MEDICAID | CU0056 | 01 | KS | MEDICARE RAILROAD | OTHER |