| Kidstlc Medical Servics, Llc | |
|
480 S Rogers Rd Olathe KS 66062-1706 | |
| (913) 324-3636 | |
| (913) 324-3894 |
| Full Name | Kidstlc Medical Servics, Llc |
|---|---|
| Speciality | Psychologist - Prescribing (medical) |
| Location | 480 S Rogers Rd, Olathe, Kansas |
| Authorized Official Name and Position | Gordon Docking (CEO) |
| Authorized Official Contact | 9133243636 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidstlc Medical Servics, Llc 480 S Rogers Rd Olathe KS 66062-1706 Ph: (913) 324-3636 | Kidstlc Medical Servics, Llc 480 S Rogers Rd Olathe KS 66062-1706 Ph: (913) 324-3636 |
| NPI Number | 1912391665 |
|---|---|
| Provider Enumeration Date | 03/20/2015 |
| Last Update Date | 03/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912391665 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | (* (Not Available)) | Primary |
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