Provider Demographics
NPI:1043349210
Name:ANIMA LLC
Entity Type:Organization
Organization Name:ANIMA LLC
Other - Org Name:SOUTHWEST PSYCHIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:GRIFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:620-624-2900
Mailing Address - Street 1:150 PLAZA DR STE F
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2779
Mailing Address - Country:US
Mailing Address - Phone:620-624-2900
Mailing Address - Fax:620-624-4050
Practice Address - Street 1:150 PLAZA DR STE F
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2779
Practice Address - Country:US
Practice Address - Phone:620-624-2900
Practice Address - Fax:620-624-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74614363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME171011OtherBLUE CROSS BLUE SHIELD
KS171011OtherMEDICARE