Provider Demographics
NPI:1538784848
Name:LUKE CARTER, LP, LLC
Entity type:Organization
Organization Name:LUKE CARTER, LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-519-1877
Mailing Address - Street 1:4601 E DOUGLAS AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1032
Mailing Address - Country:US
Mailing Address - Phone:316-337-5556
Mailing Address - Fax:316-337-5531
Practice Address - Street 1:4601 E DOUGLAS AVE STE 207
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1032
Practice Address - Country:US
Practice Address - Phone:316-337-5556
Practice Address - Fax:316-337-5531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUKE CARTER, LP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-11
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health