Organization
WICHITA NEPHROLOGY GROUP, PA
Active
Parent organization
WICHITA NEPHROLOGY GROUP, PA
Other names
ReVask Surgery Center LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WICHITA NEPHROLOGY GROUP, PA
Authorized official
WISSAM SALIBA MD (DIRECTOR)
(316) 263-5891
Entity
Organization
Contact information
Practice address
2122 N GARNETT ST, WICHITA, KS 67206-3023
(316) 636-1234
(316) 636-2630
Mailing address
2122 N GARNETT ST, WICHITA, KS 67206-3023
(316) 263-5891
(316) 263-3083
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
04-35548
KS
Other
Enumeration date
06/07/2018
Last updated
03/29/2021
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