| Eating Disorders Program Of Kansas City, Llc | |
|
400 E Red Bridge Rd Suite 304 Kansas City MO 64131-4035 | |
| (816) 942-1811 | |
| (816) 942-0419 |
| Full Name | Eating Disorders Program Of Kansas City, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 400 E Red Bridge Rd, Kansas City, Missouri |
| Authorized Official Name and Position | Mimi Zimmerman (CO-OWNER) |
| Authorized Official Contact | 8169421811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eating Disorders Program Of Kansas City, Llc 400 E Red Bridge Rd Suite 304 Kansas City MO 64131-4035 Ph: (816) 942-1811 | Eating Disorders Program Of Kansas City, Llc 400 E Red Bridge Rd Suite 304 Kansas City MO 64131-4035 Ph: (816) 942-1811 |
| NPI Number | 1750323192 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 02/26/2010 |
| Medicare PECOS PAC ID | 8729099619 |
|---|---|
| Medicare Enrollment ID | O20060505000907 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750323192 | NPI | - | NPPES |
| 13005012 | Other | MO | BCBSKC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mary Zimmerman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811923048 PECOS PAC ID: 9436160322 Enrollment ID: I20060508000143 |
| Provider Name | Carla Jeanne Oconnor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518993344 PECOS PAC ID: 3971514860 Enrollment ID: I20060508000165 |
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