Basic Information
| Provider Information | |||||||||
| NPI: | 1467900894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS UNIVERSITY SCHOOL OF MEDICINE - WICHITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7829 E ROCKHILL ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063920 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7829 E ROCKHILL ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162933850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | HEINRICHS | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF NEUROPSYCHOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 3162933850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 2731 | KS | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | 2731 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.