Healthcare Provider Details

I. General information

NPI: 1023044641
Provider Name (Legal Business Name): KANSAS CITY PSYCHIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 COLLEGE BLVD SUITE 304
OVERLAND PARK KS
66211-1799
US

IV. Provider business mailing address

4500 COLLEGE BLVD SUITE 304
OVERLAND PARK KS
66211-1799
US

V. Phone/Fax

Practice location:
  • Phone: 913-338-0400
  • Fax: 913-338-0428
Mailing address:
  • Phone: 913-338-0400
  • Fax: 913-338-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MURIEL M ADAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-338-0400