Healthcare Provider Details

I. General information

NPI: 1770513954
Provider Name (Legal Business Name): PSYCHIATRIC CARE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S 4TH ST STE 100
LEAVENWORTH KS
66048
US

IV. Provider business mailing address

7323 N NEVADA AVE
PARKVILLE MO
64152-1191
US

V. Phone/Fax

Practice location:
  • Phone: 913-651-2202
  • Fax: 913-273-1316
Mailing address:
  • Phone: 913-651-2202
  • Fax: 913-273-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0420849
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0420849
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR6E66
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0420849
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR6E66
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6E66
License Number StateMO

VIII. Authorized Official

Name: MAN MOHAN ANAND
Title or Position: PRESIDENT
Credential: MD
Phone: 913-651-2202