Basic Information
| Provider Information | |||||||||
| NPI: | 1588650717 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIA CHRISTI REGIONAL MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | MATERNAL FETAL MEDICINE-WICHITA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3832 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672013832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166813425 | ||||||||
| FaxNumber: | 3166813554 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 S CLIFTON AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672182900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168587200 | ||||||||
| FaxNumber: | 3168587204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHUMACHER | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO VCRMC | ||||||||
| AuthorizedOfficialTelephone: | 3162685108 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VIA CHRISTI REGIONAL MEDICAL CENTER INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.