Provider Demographics
NPI:1174019293
Name:WICHITA STATE UNIVERSITY STUDENT HEALTH SERVICES
Entity type:Organization
Organization Name:WICHITA STATE UNIVERSITY STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR STUDENT AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-978-3021
Mailing Address - Street 1:1845 FAIRMOUNT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0092
Mailing Address - Country:US
Mailing Address - Phone:316-978-4792
Mailing Address - Fax:316-978-3517
Practice Address - Street 1:1845 FAIRMOUNT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-0092
Practice Address - Country:US
Practice Address - Phone:316-978-4792
Practice Address - Fax:316-978-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty