Provider Demographics
NPI:1093144917
Name:MIDWEST GERIATRIC PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:MIDWEST GERIATRIC PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANKAR
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KODIDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-875-4400
Mailing Address - Street 1:900 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4191
Mailing Address - Country:US
Mailing Address - Phone:816-875-4400
Mailing Address - Fax:
Practice Address - Street 1:5900 SWOPE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-4241
Practice Address - Country:US
Practice Address - Phone:816-333-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050318012084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty