# WICHITA UROLOGY SURGERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245806876
- **Authorized official:** JENNIFER L ALE-EBRAHIM MHA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (316) 636-6110

## Contact information

- **Practice address:** 2620 N WEBB RD, WICHITA, KS 67226-8110
- **Practice address phone:** (316) 636-6176
- **Mailing address:** 2620 N WEBB RD, WICHITA, KS 67226-8110
- **Mailing address phone:** (316) 358-0813
- **Mailing address fax:** (316) 358-0314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/03/2021
- **Last updated:** 11/13/2024