Provider Demographics
NPI:1629005699
Name:ASCENSION VIA CHRISTI HOME MEDICAL WICHITA, LLC
Entity Type:Organization
Organization Name:ASCENSION VIA CHRISTI HOME MEDICAL WICHITA, LLC
Other - Org Name:VIA CHRISTI HOME MEDICAL WICHITA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-858-2124
Mailing Address - Street 1:PO BOX 1933
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1933
Mailing Address - Country:US
Mailing Address - Phone:785-537-3699
Mailing Address - Fax:
Practice Address - Street 1:2439 CLAFLIN ROAD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-537-3699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION VIA CHRISTI HOME MEDICAL WICHITA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS118140OtherBLUE CROSS/BLUE SHIELD
KS1004444280EMedicaid
KS4956590001Medicare ID - Type Unspecified