Provider Demographics
NPI:1841259587
Name:BAHRUTH, VIRGINIA (PA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:BAHRUTH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W RADIO LN
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-4011
Mailing Address - Country:US
Mailing Address - Phone:620-442-2100
Mailing Address - Fax:620-442-8945
Practice Address - Street 1:510 W RADIO LN
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-4011
Practice Address - Country:US
Practice Address - Phone:620-442-2100
Practice Address - Fax:620-442-8945
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00410363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100643760AMedicaid