WICHITA NEPHROLOGY GROUP PA NPI 1396238010

NPI Information

NPI: 1396238010
Provider Name: WICHITA NEPHROLOGY GROUP, PA

Doing Business As: REVASK SURGERY CENTER LLC

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
2122 N GARNETT ST
WICHITA, KS
ZIP 67206
Phone: (316) 636-1234
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WICHITA NEPHROLOGY GROUP, PA is an ambulatory surgical clinic center in Wichita, KS. WICHITA NEPHROLOGY GROUP, PA NPI is 1396238010. The provider is registered as an organization entity type.
The provider Is Doing Business As Revask Surgery Center Llc.

The provider's business location address is:

2122 N GARNETT ST
WICHITA, KS
ZIP 67206-023
Phone: (316) 636-1234
Fax: (316) 636-2630

The provider's authorized official is Wissam Saliba .
The authorized official title is Director and has the following contact phone number (316) 263-5891.

The CLIA number assigned to this NPI record is 17D2160355 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/7/2018 and was last updated on 3/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	04-35548	KANSAS	Yes

What is NPI?

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This page was last updated on: 4/28/2024

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