Provider Demographics
NPI:1134310154
Name:OTHMER PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:OTHMER PSYCHIATRIC CENTER
Other - Org Name:PICTURE HILLS PSYCHIATRIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIEGLINDE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OTHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-746-5555
Mailing Address - Street 1:5709 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2382
Mailing Address - Country:US
Mailing Address - Phone:816-746-5555
Mailing Address - Fax:816-746-5996
Practice Address - Street 1:5709 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2382
Practice Address - Country:US
Practice Address - Phone:816-746-5555
Practice Address - Fax:816-746-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1473101YA0400X
MO0037501041C0700X
MO20050218112084P0800X
MO338622084P0800X
MO2005027490364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005021811OtherSTATE OF MO MD LICENSE
MO497729418Medicaid
MO202302113Medicaid
MOMD-063-511LOtherCHILD AND ADOLESCENT PSYC
MOC50340Medicare UPIN
MO202302113Medicaid
MOB14E374Medicare PIN
B143852Medicare PIN