Provider Demographics
NPI:1306857628
Name:ASCENSION VIA CHRISTI IMAGING WICHITA, LLC
Entity Type:Organization
Organization Name:ASCENSION VIA CHRISTI IMAGING WICHITA, LLC
Other - Org Name:ANATOMI IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERRARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-815-1264
Mailing Address - Street 1:PO BOX 47121
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7121
Mailing Address - Country:US
Mailing Address - Phone:913-815-1264
Mailing Address - Fax:316-462-2030
Practice Address - Street 1:14700 W SAINT TERESA ST STE 150
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9611
Practice Address - Country:US
Practice Address - Phone:316-462-2020
Practice Address - Fax:316-346-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100363540DMedicaid
KS110558OtherBCBS
KS470001645Medicare PIN
KS110558OtherBCBS