Basic Information
| Provider Information | |||||||||
| NPI: | 1265497747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIA CHRISTI EMERGENCY PHYSICIAN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 47222 | ||||||||
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| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672017222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162688131 | ||||||||
| FaxNumber: | 3162914788 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 N. ST. FRANCIS | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162685775 | ||||||||
| FaxNumber: | 3162917496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 02/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | LABARCA | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 3162685161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200004860A | 05 | KS | MEDICAID | 110990 | 01 | KS | BLUE SHIELD | OTHER |