Provider Demographics
NPI:1851767032
Name:ACCIDENT AND RECOVERY CLINIC
Entity Type:Organization
Organization Name:ACCIDENT AND RECOVERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GADALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-686-0400
Mailing Address - Street 1:3810 W BOUNOUS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-1203
Mailing Address - Country:US
Mailing Address - Phone:316-686-0400
Mailing Address - Fax:316-686-0448
Practice Address - Street 1:3810 W BOUNOUS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-1203
Practice Address - Country:US
Practice Address - Phone:316-686-0400
Practice Address - Fax:316-686-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-298322083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty