Provider Demographics
NPI:1700222734
Name:WICHITA TRAN4MATION LLC
Entity Type:Organization
Organization Name:WICHITA TRAN4MATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-990-8677
Mailing Address - Street 1:1217 S LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3644
Mailing Address - Country:US
Mailing Address - Phone:316-687-0456
Mailing Address - Fax:316-687-0458
Practice Address - Street 1:1217 S LINDEN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-3644
Practice Address - Country:US
Practice Address - Phone:316-687-0456
Practice Address - Fax:316-687-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200851410BMedicaid