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General NPI Number Information
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NPI Number | 1891219911
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Entity Type | Organization
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Legal Business Name | PRIME TMS LLC
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1811 WAKARUSA DR STE 102
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City | LAWRENCE
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State | KS
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Zip | 66047-2082
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Country | US
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Telephone | 785-371-4921
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Fax | 888-965-4514
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Provider Business Mailing Address
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Address Line | 1811 WAKARUSA DR STE 102
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City | LAWRENCE
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State | KS
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Zip | 66047-2082
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Country | US
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Telephone | 785-371-4921
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Fax | 888-965-5147
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GARRETT HAGES
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Credential |
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Telephone | 785-371-4921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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