Provider Demographics
NPI:1295033066
Name:EARCARE HEARING AID CENTER WEST STREET WICHITA, INC.
Entity Type:Organization
Organization Name:EARCARE HEARING AID CENTER WEST STREET WICHITA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-269-4327
Mailing Address - Street 1:125 S WEST ST
Mailing Address - Street 2:STE 121
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2113
Mailing Address - Country:US
Mailing Address - Phone:316-440-3750
Mailing Address - Fax:316-440-3755
Practice Address - Street 1:125 S WEST ST
Practice Address - Street 2:STE 121
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2113
Practice Address - Country:US
Practice Address - Phone:316-440-3750
Practice Address - Fax:316-440-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1329332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment