Provider Demographics
NPI:1932410453
Name:VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS, INC
Entity Type:Organization
Organization Name:VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS, INC
Other - Org Name:VIA CHRISTI HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-268-8080
Mailing Address - Street 1:2622 W CENTRAL AVE
Mailing Address - Street 2:#101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4969
Mailing Address - Country:US
Mailing Address - Phone:316-946-5113
Mailing Address - Fax:316-946-5105
Practice Address - Street 1:2622 W CENTRAL AVE
Practice Address - Street 2:#101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4969
Practice Address - Country:US
Practice Address - Phone:316-946-5113
Practice Address - Fax:316-946-5105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-30
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty