# HEALING WATERS WICHITA LC

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

## Provider details

- **NPI number:** 1407144058
- **Authorized official:** AMANDA GORECKI (PRESIDENT)
- **Authorized official phone:** (316) 262-2995

## Contact information

- **Practice address:** 2000 N ROCK RD, SUITE 100, WICHITA, KS 67206-1201
- **Practice address phone:** (316) 262-2995
- **Practice address fax:** (316) 262-2546
- **Mailing address:** 33 BUFORD VILLAGE WAY, SUITE 325, BUFORD, GA 30518-8843
- **Mailing address phone:** (678) 730-7780
- **Mailing address fax:** (678) 730-7786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2011
- **Last updated:** 03/30/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200468790A | — | OK |
| 05 | — | 201097690A | — | KS |