Provider Demographics
NPI:1083688980
Name:COLLEGE HILL OB/GYN, P.A.
Entity type:Organization
Organization Name:COLLEGE HILL OB/GYN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIGNON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-871-1148
Mailing Address - Street 1:3233 E 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3202
Mailing Address - Country:US
Mailing Address - Phone:316-683-6766
Mailing Address - Fax:316-616-0073
Practice Address - Street 1:3233 E 2ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3202
Practice Address - Country:US
Practice Address - Phone:316-683-6766
Practice Address - Fax:316-616-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100392890AMedicaid
KS17D0927901OtherCLIA ID #
KS110026Medicare ID - Type UnspecifiedMEDICARE ID #