Provider Demographics
NPI:1356305999
Name:EASTERN JACKSON COUNTY PSYCHIATRIC ASSOC INC
Entity Type:Organization
Organization Name:EASTERN JACKSON COUNTY PSYCHIATRIC ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-373-1911
Mailing Address - Street 1:17221 E 23RD ST S
Mailing Address - Street 2:#206
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1803
Mailing Address - Country:US
Mailing Address - Phone:816-373-1911
Mailing Address - Fax:
Practice Address - Street 1:17221 E 23RD ST S
Practice Address - Street 2:#206
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1803
Practice Address - Country:US
Practice Address - Phone:816-373-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08304016OtherBCBSKC
MO10712013OtherBCBSKC
MO10712013OtherBCBSKC