| Prime Tms Llc | |
|
1811 Wakarusa Dr Ste 102 Lawrence KS 66047-2082 | |
| (785) 371-4921 | |
| (888) 965-4514 |
| Full Name | Prime Tms Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1811 Wakarusa Dr Ste 102, Lawrence, Kansas |
| Authorized Official Name and Position | Garrett Hages (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7853714921 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Tms Llc 1811 Wakarusa Dr Ste 102 Lawrence KS 66047-2082 Ph: (785) 371-4921 | Prime Tms Llc 1811 Wakarusa Dr Ste 102 Lawrence KS 66047-2082 Ph: (785) 371-4921 |
| NPI Number | 1891219911 |
|---|---|
| Provider Enumeration Date | 07/31/2017 |
| Last Update Date | 08/01/2023 |
| Certification Date | 08/01/2023 |
| Medicare PECOS PAC ID | 8820357908 |
|---|---|
| Medicare Enrollment ID | O20180117002799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891219911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 332900000X | Non-pharmacy Dispensing Site | (* (Not Available)) | Secondary |
| Provider Name | Katrina L Porter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639289200 PECOS PAC ID: 4587669254 Enrollment ID: I20061002000494 |
| Provider Name | Taylor L Porter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760423362 PECOS PAC ID: 0446381081 Enrollment ID: I20100626000198 |
| Provider Name | Gina Rasnic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679924633 PECOS PAC ID: 9638503535 Enrollment ID: I20191231002251 |
| Provider Name | Michelle Lynn Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265858567 PECOS PAC ID: 8022422914 Enrollment ID: I20210204002466 |
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