Healthcare Provider Details

I. General information

NPI: 1891219911
Provider Name (Legal Business Name): PRIME TMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WAKARUSA DR STE 102
LAWRENCE KS
66047-2082
US

IV. Provider business mailing address

1811 WAKARUSA DR STE 102
LAWRENCE KS
66047-2082
US

V. Phone/Fax

Practice location:
  • Phone: 785-371-4921
  • Fax: 888-965-4514
Mailing address:
  • Phone: 785-371-4921
  • Fax: 888-965-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: GARRETT HAGES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 785-371-4921