MEDICARE: MIDWEST GERIATRIC PSYCHIATRIC SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0015X	Psychosomatic Medicine Physician	2005031801	MO

General Provider Information

NPI Number	:	1093144917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST GERIATRIC PSYCHIATRIC SERVICES PC

Provider Business Mailing Address
First Line	:	900 SW 33RD ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4191
Country	:	US
Telephone Number	:	816-875-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 SWOPE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-4241
Country	:	US
Telephone Number	:	816-333-2700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANKAR REDDY KODIDHI
Credential	:	MD
Telephone Number	:	816-875-4400

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	11/04/2013

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