Provider Demographics
NPI:1043723497
Name:MENTAL HEALTH MEDICATION SERVICES, P.A.
Entity Type:Organization
Organization Name:MENTAL HEALTH MEDICATION SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:F
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-303-0333
Mailing Address - Street 1:2718 W BENTBAY CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2335
Mailing Address - Country:US
Mailing Address - Phone:316-208-8393
Mailing Address - Fax:
Practice Address - Street 1:1421 E 2ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4119
Practice Address - Country:US
Practice Address - Phone:316-303-0333
Practice Address - Fax:316-847-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74595-0912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty