Basic Information
| Provider Information | |||||||||
| NPI: | 1194041608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WICHITA ECHOCARDIOGRAPHERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 E. CENTRAL | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672062367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867327 | ||||||||
| FaxNumber: | 3166861557 | ||||||||
| Practice Location | |||||||||
| Address1: | 8080 E. CENTRAL | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672062367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867327 | ||||||||
| FaxNumber: | 3166861557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 02/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCCOY | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3166867327 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.