MEDICARE: TRBHS PHYSICIANS GROUP

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	2084P0800X	Psychiatry Physician	349-23	MO

General Provider Information

NPI Number	:	1407151608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRBHS PHYSICIANS GROUP

Provider Business Mailing Address
First Line	:	5121 RAYTOWN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-2141
Country	:	US
Telephone Number	:	816-382-6300
Fax Number	:	816-382-6810

Provider Business Practice Location Address
First Line	:	5121 RAYTOWN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-2141
Country	:	US
Telephone Number	:	816-382-6300
Fax Number	:	816-382-6810

Authorized Official
Title or Position	:	CEO
Name	:	MR. KEVIN YOUNG
Credential	:
Telephone Number	:	816-382-6313

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	03/18/2011

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