Provider Demographics
NPI:1831185065
Name:ASCENSION VIA CHRISTI HOSPITALS WICHITA INC.
Entity type:Organization
Organization Name:ASCENSION VIA CHRISTI HOSPITALS WICHITA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-858-4933
Mailing Address - Street 1:PO BOX 48574
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-8574
Mailing Address - Country:US
Mailing Address - Phone:316-689-5911
Mailing Address - Fax:316-691-6788
Practice Address - Street 1:1151 N ROCK ROAD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-689-5235
Practice Address - Fax:316-691-6788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION VIA CHRISTI HOSPITALS WICHITA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110999Medicare PIN