Provider Demographics
NPI:1770513954
Name:PSYCHIATRIC CARE ASSOCIATES PA
Entity type:Organization
Organization Name:PSYCHIATRIC CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAN
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:ANAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-651-2202
Mailing Address - Street 1:7323 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1191
Mailing Address - Country:US
Mailing Address - Phone:913-651-2202
Mailing Address - Fax:913-273-1316
Practice Address - Street 1:3315 S 4TH ST
Practice Address - Street 2:STE 100
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-651-2202
Practice Address - Fax:913-273-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04208492084P0800X, 2084P0804X, 2084P0805X
MOR6E662084P0804X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100113500AMedicaid
MO202632600Medicaid
D93744Medicare UPIN
MO202632600Medicaid
MOD870000Medicare ID - Type Unspecified