Provider Demographics
NPI:1336952415
Name:WICHITA PSYCHIATRIC GROUP LLC
Entity type:Organization
Organization Name:WICHITA PSYCHIATRIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-350-4014
Mailing Address - Street 1:7804 E FUNSTON ST # 219
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3107
Mailing Address - Country:US
Mailing Address - Phone:316-350-4014
Mailing Address - Fax:
Practice Address - Street 1:7447 W VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-2625
Practice Address - Country:US
Practice Address - Phone:316-372-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty