| Dwight St Clair Do Pa | |
|
1148 S Hillside St Suite 104 Wichita KS 67211-4005 | |
| (316) 687-0006 | |
| (316) 687-0328 |
| Full Name | Dwight St Clair Do Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1148 S Hillside St, Wichita, Kansas |
| Authorized Official Name and Position | Dwight S St Clair (BOARD CERTIFIED PSYCHIATRIST) |
| Authorized Official Contact | 3166870006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dwight St Clair Do Pa 1148 S Hillside St Suite 104 Wichita KS 67211-4005 Ph: (316) 687-0006 | Dwight St Clair Do Pa 1148 S Hillside St Suite 104 Wichita KS 67211-4005 Ph: (316) 687-0006 |
| NPI Number | 1225396443 |
|---|---|
| Provider Enumeration Date | 04/25/2012 |
| Last Update Date | 04/25/2012 |
| Medicare PECOS PAC ID | 8820250871 |
|---|---|
| Medicare Enrollment ID | O20120508000734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225396443 | NPI | - | NPPES |
| 100232310B | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 05-24105 (Kansas) | Primary |
| Provider Name | Dwight S St Clair |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437175254 PECOS PAC ID: 5496796542 Enrollment ID: I20050518001074 |
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