Provider Demographics
NPI:1053487579
Name:HUNTER HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:HUNTER HEALTH CLINIC, INC
Other - Org Name:HUNTER HEALTH CLINIC AT BROOKSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-262-2415
Mailing Address - Street 1:2318 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4436
Mailing Address - Country:US
Mailing Address - Phone:316-262-2415
Mailing Address - Fax:316-262-0138
Practice Address - Street 1:2750 S ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1304
Practice Address - Country:US
Practice Address - Phone:316-652-0152
Practice Address - Fax:316-652-0928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1376618348
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003947OtherBCBS GROUP
KS100212200CMedicaid
KS171828Medicare Oscar/Certification
KS003947Medicare PIN