| Lilac Center Llc | |
|
2029 Buchanan St Kansas City MO 64116-3405 | |
| (816) 221-0305 | |
| (816) 221-9121 |
| Full Name | Lilac Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2029 Buchanan St, Kansas City, Missouri |
| Authorized Official Name and Position | Amy M Tibbitts (DIRECTOR) |
| Authorized Official Contact | 8162210305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lilac Center Llc 2029 Buchanan St Kansas City MO 64116-3405 Ph: (816) 221-0305 | Lilac Center Llc 2029 Buchanan St Kansas City MO 64116-3405 Ph: (816) 221-0305 |
| NPI Number | 1477877223 |
|---|---|
| Provider Enumeration Date | 03/23/2010 |
| Last Update Date | 10/23/2024 |
| Certification Date | 10/23/2024 |
| Medicare PECOS PAC ID | 2961625462 |
|---|---|
| Medicare Enrollment ID | O20140602002446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477877223 | NPI | - | NPPES |
| 830117171 | Medicaid | MO | |
| 201354450A | Medicaid | KS |
| Provider Name | Amy M Tibbitts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841349933 PECOS PAC ID: 2860615366 Enrollment ID: I20140701000521 |
| Provider Name | Debora Dias Ferreira |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831644889 PECOS PAC ID: 0749577625 Enrollment ID: I20180327001592 |
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