Provider Demographics
NPI:1720445950
Name:PERFORMANCE HEALTH, PA
Entity Type:Organization
Organization Name:PERFORMANCE HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SEBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-260-9005
Mailing Address - Street 1:4342 N RUSHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1488
Mailing Address - Country:US
Mailing Address - Phone:316-706-2496
Mailing Address - Fax:
Practice Address - Street 1:10111 E 21ST ST N STE 315
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3581
Practice Address - Country:US
Practice Address - Phone:316-260-9005
Practice Address - Fax:316-260-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431068261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care