Provider Demographics
NPI:1225396443
Name:DWIGHT ST CLAIR DO PA
Entity Type:Organization
Organization Name:DWIGHT ST CLAIR DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:S
Authorized Official - Last Name:ST CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-687-0006
Mailing Address - Street 1:1148 S HILLSIDE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4005
Mailing Address - Country:US
Mailing Address - Phone:316-687-0006
Mailing Address - Fax:316-687-0328
Practice Address - Street 1:1148 S HILLSIDE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4005
Practice Address - Country:US
Practice Address - Phone:316-687-0006
Practice Address - Fax:316-687-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-241052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100232310BMedicaid
KSF29867Medicare UPIN
KS100232310BMedicaid