| Professional Behavioral Health Medicine | |
|
1260 Sw Topeka Blvd Topeka KS 66612-1815 | |
| (785) 633-9241 | |
| (785) 670-8403 |
| Full Name | Professional Behavioral Health Medicine |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1260 Sw Topeka Blvd, Topeka, Kansas |
| Authorized Official Name and Position | Tanja N Roth (APRN) |
| Authorized Official Contact | 7856339241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Behavioral Health Medicine 1260 Sw Topeka Blvd Topeka KS 66612-1815 Ph: (785) 633-9241 | Professional Behavioral Health Medicine 1260 Sw Topeka Blvd Topeka KS 66612-1815 Ph: (785) 633-9241 |
| NPI Number | 1447621651 |
|---|---|
| Provider Enumeration Date | 10/14/2015 |
| Last Update Date | 05/16/2023 |
| Certification Date | 05/16/2023 |
| Medicare PECOS PAC ID | 7810206240 |
|---|---|
| Medicare Enrollment ID | O20151026000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447621651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 5374846112 (Kansas) | Primary |
| Provider Name | Tanja N Roth |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1316018518 PECOS PAC ID: 5597718254 Enrollment ID: I20141113000407 |
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