Basic Information
| Provider Information | |||||||||
| NPI: | 1295886984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RALPH BHARATI, MD,PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUBSTANCE ABUSETREATMENT OUITPATIENT PROGRAMS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8911 E ORME ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672072423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867884 | ||||||||
| FaxNumber: | 3166860036 | ||||||||
| Practice Location | |||||||||
| Address1: | 8911 E ORME ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672072423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867884 | ||||||||
| FaxNumber: | 3166860036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3166867884 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 436 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.