Provider Demographics
NPI:1467448696
Name:VIA CHRISTI HOSPITALS WICHITA, INC.
Entity Type:Organization
Organization Name:VIA CHRISTI HOSPITALS WICHITA, INC.
Other - Org Name:VIA CHRISTI FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LABARCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-268-5161
Mailing Address - Street 1:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1897
Mailing Address - Country:US
Mailing Address - Phone:316-268-8131
Mailing Address - Fax:316-291-4788
Practice Address - Street 1:1121 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2912
Practice Address - Country:US
Practice Address - Phone:316-689-5500
Practice Address - Fax:316-691-6719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIA CHRISTI HOSPITALS WICHITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-22
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080640DMedicaid
KS3213820002Medicare NSC
KS110173Medicare PIN