Provider Demographics
NPI:1073714325
Name:RALPH BHARATI, MD,PA
Entity Type:Organization
Organization Name:RALPH BHARATI, MD,PA
Other - Org Name:LAB SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-686-7884
Mailing Address - Street 1:8911 E ORME ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2423
Mailing Address - Country:US
Mailing Address - Phone:316-686-7884
Mailing Address - Fax:316-686-0036
Practice Address - Street 1:8911 E ORME ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2423
Practice Address - Country:US
Practice Address - Phone:316-686-7884
Practice Address - Fax:316-686-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS117918OtherBCBS LAB