Provider Demographics
NPI:1083604789
Name:ASCENSION VIA CHRISTI REHABILITATION HOSPITAL, INC.
Entity Type:Organization
Organization Name:ASCENSION VIA CHRISTI REHABILITATION HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-858-4933
Mailing Address - Street 1:1151 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1262
Mailing Address - Country:US
Mailing Address - Phone:316-634-3400
Mailing Address - Fax:316-634-1141
Practice Address - Street 1:1151 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1262
Practice Address - Country:US
Practice Address - Phone:316-634-3400
Practice Address - Fax:316-634-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH087006283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1037OtherBLUE CROSS OF KANSAS
KS115093OtherBLUE SHIELD OF KANSAS
KS100105420AMedicaid
KS100105420AMedicaid