Provider Demographics
NPI:1922415215
Name:MEDWISE SERVICES
Entity Type:Organization
Organization Name:MEDWISE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY RELATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-708-1830
Mailing Address - Street 1:PO BOX 8793
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0793
Mailing Address - Country:US
Mailing Address - Phone:316-708-1830
Mailing Address - Fax:
Practice Address - Street 1:801 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4704
Practice Address - Country:US
Practice Address - Phone:316-708-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)