Basic Information
| Provider Information | |||||||||
| NPI: | 1639143712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF KANSAS SCHOOL OF MEDICINE WICHITA MEDICAL PRACTICE ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N KANSAS | ||||||||
| Address2: | STE 3049 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162932620 | ||||||||
| FaxNumber: | 3162931882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N MINNEAPOLIS | ||||||||
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| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162932620 | ||||||||
| FaxNumber: | 3162931882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | RYAN | ||||||||
| AuthorizedOfficialFirstName: | LEWIS | ||||||||
| AuthorizedOfficialMiddleName: | AARON | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3162932620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, MBA, FACMPE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.