Organization
LIFELINE STOP SMOKING CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY SCANLAN MD (OWNER/MANAGING PARTNER)
(316) 640-0804
Entity
Organization
Contact information
Practice address
650 N CARRIAGE PKWY, SUITE 135, WICHITA, KS 67208-4507
(316) 640-0804
(316) 685-8247
Mailing address
650 N CARRIAGE PKWY, SUITE 135, WICHITA, KS 67208-4507
(316) 640-0804
(316) 685-8247
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
17663
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103516
BCBS NON-PAR. PROVIDER #
KS
Enumeration date
11/02/2006
Last updated
08/22/2020
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