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General NPI Number Information
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NPI Number | 1184995441
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Entity Type | Organization
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Legal Business Name | PATMOS HEALTH CARE LLC
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 10151 UNIVERSITY BLVD
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City | ORLANDO
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State | FL
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Zip | 32817-1904
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Country | US
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Telephone | 816-516-7114
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Fax | 816-761-1899
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Provider Business Mailing Address
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Address Line | 2900 SW 13TH ST
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City | LEES SUMMIT
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State | MO
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Zip | 64081-3800
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Country | US
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Telephone | 816-516-7114
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Fax | 816-761-1899
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG ERISMAN
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Credential | PSYD
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Telephone | 816-516-7114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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