Provider Demographics
NPI:1043563349
Name:SOUTH WIND WOMEN'S CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH WIND WOMEN'S CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-425-3215
Mailing Address - Street 1:5107 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1625
Mailing Address - Country:US
Mailing Address - Phone:316-260-6934
Mailing Address - Fax:888-724-3239
Practice Address - Street 1:5101 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1625
Practice Address - Country:US
Practice Address - Phone:316-425-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUST WOMEN FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043563349OtherNPI