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General NPI Number Information
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NPI Number | 1043723497
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH MEDICATION SERVICES, P.A.
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1421 E 2ND ST N
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City | WICHITA
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State | KS
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Zip | 67214-4119
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Country | US
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Telephone | 316-303-0333
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Fax | 316-847-7093
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Provider Business Mailing Address
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Address Line | 2718 W BENTBAY CIR
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City | WICHITA
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State | KS
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Zip | 67204-2335
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Country | US
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Telephone | 316-208-8393
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOB F. BORN
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Credential | APRN
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Telephone | 316-303-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 53-74595-091
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License Number State | KS
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