1699817106 NPI number — MS. CAMILLE M KORSCHGEN CTRS

Table of content: MS. CAMILLE M KORSCHGEN CTRS (NPI 1699817106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699817106 NPI number — MS. CAMILLE M KORSCHGEN CTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORSCHGEN
Provider First Name:
CAMILLE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CTRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699817106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7003 W 34TH ST N
Provider Second Line Business Mailing Address:
APT. 1202
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67205-2562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-773-3014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1151 N ROCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67206-1262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-634-3400
Provider Business Practice Location Address Fax Number:
316-634-1141
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225800000X , with the licence number:  41490 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41490 . This is a "NATIONAL TR CERTIFICATION" identifier . This identifiers is of the category "OTHER".




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