| Mccd Ks Psychiatry Services Pa | |
|
8101 College Blvd Ste 100 Overland Park KS 66210-2671 | |
| (917) 634-5311 | |
| Not Available |
| Full Name | Mccd Ks Psychiatry Services Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8101 College Blvd Ste 100, Overland Park, Kansas |
| Authorized Official Name and Position | Georgia Gaveras (OWNER/CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 9173097915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mccd Ks Psychiatry Services Pa 109 W 27th St # 5s New York NY 10001-6208 Ph: () - | Mccd Ks Psychiatry Services Pa 8101 College Blvd Ste 100 Overland Park KS 66210-2671 Ph: (917) 634-5311 |
| NPI Number | 1487422234 |
|---|---|
| Provider Enumeration Date | 12/12/2023 |
| Last Update Date | 03/18/2024 |
| Certification Date | 03/18/2024 |
| Medicare PECOS PAC ID | 4385094598 |
|---|---|
| Medicare Enrollment ID | O20240102000281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487422234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Tiffany Abtahi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710383963 PECOS PAC ID: 6709262199 Enrollment ID: I20230503002968 |
| Provider Name | Gerald Matthews |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649518697 PECOS PAC ID: 5991182727 Enrollment ID: I20230522002862 |
| Provider Name | Stephen Byrd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710908330 PECOS PAC ID: 1153502620 Enrollment ID: I20230606001146 |
| Provider Name | Georgia Gaveras |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801951090 PECOS PAC ID: 3375699838 Enrollment ID: I20230613002073 |
| Provider Name | Mary Stephenson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962512707 PECOS PAC ID: 5991755712 Enrollment ID: I20230721003245 |
| Provider Name | Rishell Tsujimoto-ryzewski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558603118 PECOS PAC ID: 4789803776 Enrollment ID: I20231006002408 |
| Provider Name | Jason Kudurogianis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205192077 PECOS PAC ID: 2567740269 Enrollment ID: I20231206001679 |
| Provider Name | Marla Richard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578720934 PECOS PAC ID: 0345528204 Enrollment ID: I20240319003469 |
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