Provider Demographics
NPI:1922330794
Name:MIDWEST GASTROENTEROLOGY CLINICS PA
Entity Type:Organization
Organization Name:MIDWEST GASTROENTEROLOGY CLINICS PA
Other - Org Name:RAGU C CHAPARALA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAPARALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-267-7175
Mailing Address - Street 1:PO BOX 3211
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3211
Mailing Address - Country:US
Mailing Address - Phone:316-267-7175
Mailing Address - Fax:316-267-9093
Practice Address - Street 1:2160 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2138
Practice Address - Country:US
Practice Address - Phone:316-267-7175
Practice Address - Fax:316-267-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100284260DMedicaid
KSF91252Medicare UPIN