Provider Demographics
NPI:1265472088
Name:MIDWEST PSYCHIATRIC CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:MIDWEST PSYCHIATRIC CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-523-0103
Mailing Address - Street 1:200 NE MISSOURI RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4720
Mailing Address - Country:US
Mailing Address - Phone:816-523-0103
Mailing Address - Fax:816-361-6471
Practice Address - Street 1:200 NE MISSOURI RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4720
Practice Address - Country:US
Practice Address - Phone:816-523-0103
Practice Address - Fax:816-361-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3950000Medicare ID - Type UnspecifiedMEDICARE