Provider Demographics
NPI:1336420793
Name:NEWMAN UNIVERSITY
Entity Type:Organization
Organization Name:NEWMAN UNIVERSITY
Other - Org Name:NEWMAN UNIVERSITY SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATHLETIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-942-4291
Mailing Address - Street 1:3100 W MCCORMICK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2008
Mailing Address - Country:US
Mailing Address - Phone:316-942-4291
Mailing Address - Fax:316-942-4483
Practice Address - Street 1:3100 MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2008
Practice Address - Country:US
Practice Address - Phone:316-942-4291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty