Provider Demographics
NPI:1649754789
Name:WICHITA AMBULATORY ANESTHESIA PROVIDERS LLC
Entity Type:Organization
Organization Name:WICHITA AMBULATORY ANESTHESIA PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SOUNIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUANGPRASEUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-516-7361
Mailing Address - Street 1:330 W 2ND ST N UNIT 3358
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0239
Mailing Address - Country:US
Mailing Address - Phone:316-516-7361
Mailing Address - Fax:
Practice Address - Street 1:818 N EMPORIA ST STE 108
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3725
Practice Address - Country:US
Practice Address - Phone:316-281-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty