Basic Information
| Provider Information | |||||||||
| NPI: | 1184037509 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MH HEALTH OF KANSAS, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MH HEALTH OF KANSAS AT PERCEPTIVE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5 | ||||||||
| Address2: | |||||||||
| City: | WINOOSKI | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054040005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028570400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8950 RENNER BLVD | ||||||||
| Address2: | C/O PERCEPTIVE SOFTWARE HEALTH CENTER | ||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132276001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2014 | ||||||||
| LastUpdateDate: | 06/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | RAMAKRISHNAN | ||||||||
| AuthorizedOfficialFirstName: | GOMATHI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9138956550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MH HEALTH OF KANSAS, PA | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.