Provider Demographics
NPI:1811273931
Name:THERESA A. FLAIGLE
Entity type:Organization
Organization Name:THERESA A. FLAIGLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-869-2220
Mailing Address - Street 1:123 N. TYLER RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3726
Mailing Address - Country:US
Mailing Address - Phone:316-869-2220
Mailing Address - Fax:316-869-2221
Practice Address - Street 1:123 N. TYLER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3726
Practice Address - Country:US
Practice Address - Phone:316-869-2220
Practice Address - Fax:316-869-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7543251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7543OtherSTATE LICENSE