Provider Demographics
NPI:1255531380
Name:WICHITA PARKINSON'S CENTER, LLC
Entity type:Organization
Organization Name:WICHITA PARKINSON'S CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:WIDNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-712-4061
Mailing Address - Street 1:2250 N ROCK RD
Mailing Address - Street 2:SUITE 118-274
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2331
Mailing Address - Country:US
Mailing Address - Phone:316-712-4061
Mailing Address - Fax:316-854-0106
Practice Address - Street 1:8338 W 13TH ST N
Practice Address - Street 2:SUITE 217
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2900
Practice Address - Country:US
Practice Address - Phone:316-729-1135
Practice Address - Fax:316-729-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04324142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty