Provider Demographics
NPI:1699264697
Name:OMODING, SAMUEL O
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:O
Last Name:OMODING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 S OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2351
Mailing Address - Country:US
Mailing Address - Phone:205-601-9296
Mailing Address - Fax:316-854-5074
Practice Address - Street 1:556 S OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2351
Practice Address - Country:US
Practice Address - Phone:205-601-9296
Practice Address - Fax:316-854-5074
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)