Provider Demographics
NPI:1043228984
Name:WEST WICHITA FAMILY PHYSICIANS, P.A.
Entity Type:Organization
Organization Name:WEST WICHITA FAMILY PHYSICIANS, P.A.
Other - Org Name:WEST WICHITA MINOR EMERGENCY OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MBA
Authorized Official - Phone:316-722-6260
Mailing Address - Street 1:8200 W CENTRAL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-9503
Mailing Address - Country:US
Mailing Address - Phone:316-721-4910
Mailing Address - Fax:316-721-2004
Practice Address - Street 1:8200 W CENTRAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-9503
Practice Address - Country:US
Practice Address - Phone:316-721-4910
Practice Address - Fax:316-721-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCK4051OtherTRAVELERS MEDICARE
KS110354OtherBLUE CROSS BLUE SHIELD
KS110354Medicare ID - Type Unspecified