Provider Demographics
NPI:1720655012
Name:MJM KANSAS INTERNAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:MJM KANSAS INTERNAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HORVATICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-614-4969
Mailing Address - Street 1:3161 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8104
Mailing Address - Country:US
Mailing Address - Phone:316-669-0777
Mailing Address - Fax:316-669-0009
Practice Address - Street 1:3161 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8104
Practice Address - Country:US
Practice Address - Phone:316-669-0777
Practice Address - Fax:316-669-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty