Provider Demographics
NPI:1073523452
Name:ASCENSION MEDICAL GROUP VIA CHRISTI, PA
Entity Type:Organization
Organization Name:ASCENSION MEDICAL GROUP VIA CHRISTI, PA
Other - Org Name:VIA CHRISTI CLINIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR,PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SUZANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-719-1201
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:1947 N FOUNDERS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3548
Practice Address - Country:US
Practice Address - Phone:316-613-4931
Practice Address - Fax:316-613-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS087015261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS245716OtherCOVENTRY
KSCC8848OtherMEDICARE RAILROAD
KSP00294493OtherRR MEDICARE
KS101103OtherHPK
KS112223OtherBCBS
KS14908OtherPHS
KSCU0056OtherMEDICARE RAILROAD
KS200726520HMedicaid
KSCC8849OtherMEDICARE RAILROAD
KS112042Medicare ID - Type Unspecified