Basic Information
| Provider Information | |||||||||
| NPI: | 1417967365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION MEDICAL GROUP VIA CHRISTI, PA | ||||||||
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| OtherOrganizationName: | ASCENSION VIA CHRISTI SLEEP CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8035 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672080035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166899135 | ||||||||
| FaxNumber: | 3166899102 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 N CARRIAGE PKWY | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672084511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166512250 | ||||||||
| FaxNumber: | 3166859391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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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 | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 500073 | 01 | KS | HPK | OTHER | 10051 | 01 | KS | PHS | OTHER | 048497 | 01 | KS | BCBS LEGACY ID DURABLE MEDICAL | OTHER |