Provider Demographics
NPI:1598969784
Name:EAR NOSE & THROAT SURGICAL GROUP OF WICHITA PA
Entity Type:Organization
Organization Name:EAR NOSE & THROAT SURGICAL GROUP OF WICHITA PA
Other - Org Name:ENT SURGICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OTOLARYNGOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-945-5245
Mailing Address - Street 1:1301 N WEST ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1347
Mailing Address - Country:US
Mailing Address - Phone:316-945-5245
Mailing Address - Fax:316-945-5618
Practice Address - Street 1:1301 N WEST ST
Practice Address - Street 2:STE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1347
Practice Address - Country:US
Practice Address - Phone:316-945-5245
Practice Address - Fax:316-945-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016607OtherMEDICARE PROVIDER NUMBER
KS016607OtherMEDICARE PROVIDER NUMBER