Provider Demographics
NPI:1467500199
Name:VIA CHRISTI REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:VIA CHRISTI REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD CERTIFIED ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LATC
Authorized Official - Phone:316-942-4291
Mailing Address - Street 1:3100 W MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2008
Mailing Address - Country:US
Mailing Address - Phone:316-942-4291
Mailing Address - Fax:316-942-4483
Practice Address - Street 1:3100 W MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2008
Practice Address - Country:US
Practice Address - Phone:316-942-4291
Practice Address - Fax:316-942-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-000372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty