Provider Demographics
NPI:1972308245
Name:WICHITA STATE UNIVERSITY
Entity type:Organization
Organization Name:WICHITA STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MLS
Authorized Official - Phone:316-978-8600
Mailing Address - Street 1:4174 S OLIVER ST BLDG 174H
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-2142
Mailing Address - Country:US
Mailing Address - Phone:316-978-8600
Mailing Address - Fax:316-978-8610
Practice Address - Street 1:4174 S OLIVER ST BLDG 174H
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-2142
Practice Address - Country:US
Practice Address - Phone:316-978-8600
Practice Address - Fax:316-978-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory