| Midamericare Pllc | |
|
2900 Sw 13th St Lees Summit MO 64081-3800 | |
| (816) 516-7114 | |
| Not Available |
| Full Name | Midamericare Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 2900 Sw 13th St, Lees Summit, Missouri |
| Authorized Official Name and Position | Craig Erisman (OWNER) |
| Authorized Official Contact | 8165167114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midamericare Pllc 2900 Sw 13th St Lees Summit MO 64081-3800 Ph: (816) 516-7114 | Midamericare Pllc 2900 Sw 13th St Lees Summit MO 64081-3800 Ph: (816) 516-7114 |
| NPI Number | 1609268994 |
|---|---|
| Provider Enumeration Date | 02/24/2015 |
| Last Update Date | 02/24/2015 |
| Medicare PECOS PAC ID | 9234455734 |
|---|---|
| Medicare Enrollment ID | O20150227000718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609268994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (Arkansas) | Primary |
| Provider Name | Craig Erisman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154449676 PECOS PAC ID: 9638130867 Enrollment ID: I20150227001201 |
| Provider Name | Jacqueline Brown-allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245656602 PECOS PAC ID: 6507087772 Enrollment ID: I20160229002649 |
| Provider Name | Heather Zelaya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417146986 PECOS PAC ID: 4880991397 Enrollment ID: I20160329001514 |
| Provider Name | Bobby Ray Linville |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225097033 PECOS PAC ID: 7214267491 Enrollment ID: I20191001003437 |
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