Provider Demographics
NPI:1891219911
Name:PRIME TMS LLC
Entity Type:Organization
Organization Name:PRIME TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-371-4921
Mailing Address - Street 1:1811 WAKARUSA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2082
Mailing Address - Country:US
Mailing Address - Phone:785-371-4921
Mailing Address - Fax:888-965-5147
Practice Address - Street 1:1811 WAKARUSA DR STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2082
Practice Address - Country:US
Practice Address - Phone:785-371-4921
Practice Address - Fax:888-965-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty