1770513954 NPI number — PSYCHIATRIC CARE ASSOCIATES PA

Table of content: (NPI 1770513954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770513954 NPI number — PSYCHIATRIC CARE ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC CARE ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770513954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7323 N NEVADA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64152-1191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-651-2202
Provider Business Mailing Address Fax Number:
913-273-1316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 S 4TH ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-651-2202
Provider Business Practice Location Address Fax Number:
913-273-1316
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANAND
Authorized Official First Name:
MAN
Authorized Official Middle Name:
MOHAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-651-2202

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0420849 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: R6E66 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 0420849 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: R6E66 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 0420849 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: R6E66 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100113500A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202632600 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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