# WICHITA NEPHROLOGY GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WICHITA NEPHROLOGY GROUP, PA
- **Other names:** ReVask Surgery Center LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396238010
- **Legal business name:** WICHITA NEPHROLOGY GROUP, PA
- **Authorized official:** WISSAM SALIBA MD (DIRECTOR)
- **Authorized official phone:** (316) 263-5891

## Contact information

- **Practice address:** 2122 N GARNETT ST, WICHITA, KS 67206-3023
- **Practice address phone:** (316) 636-1234
- **Practice address fax:** (316) 636-2630
- **Mailing address:** 2122 N GARNETT ST, WICHITA, KS 67206-3023
- **Mailing address phone:** (316) 263-5891
- **Mailing address fax:** (316) 263-3083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 04-35548 | KS | Yes |

## Other

- **Enumeration date:** 06/07/2018
- **Last updated:** 03/29/2021