Provider Demographics
NPI:1982691242
Name:MENGES, JASON JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JAMES
Last Name:MENGES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 E 32ND ST N STE 125
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2644
Mailing Address - Country:US
Mailing Address - Phone:316-330-3636
Mailing Address - Fax:866-378-4552
Practice Address - Street 1:8110 E 32ND ST N STE 125
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2644
Practice Address - Country:US
Practice Address - Phone:316-330-3636
Practice Address - Fax:866-378-4552
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP98907Medicare UPIN