Provider Demographics
NPI:1093882276
Name:HUNTER HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:HUNTER HEALTH CLINIC, INC
Other - Org Name:HUNTER HEALTH CLINIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-262-3611
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:316-262-3611
Mailing Address - Fax:316-262-0741
Practice Address - Street 1:2318 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4436
Practice Address - Country:US
Practice Address - Phone:316-262-3611
Practice Address - Fax:316-262-0741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1376618348
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212200AMedicaid
KS100212200AMedicaid
KS116036Medicare Oscar/Certification