| Renu Brain Treatment Center Llc | |
|
9237 Ward Pkwy Ste 240 Kansas City MO 64114-3330 | |
| (816) 799-7996 | |
| Not Available |
| Full Name | Renu Brain Treatment Center Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 9237 Ward Pkwy Ste 240, Kansas City, Missouri |
| Authorized Official Name and Position | Lyndsay Denae South (OWNER) |
| Authorized Official Contact | 8163211414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renu Brain Treatment Center Llc 9237 Ward Pkwy Ste 240 Kansas City MO 64114-3330 Ph: (816) 312-1414 | Renu Brain Treatment Center Llc 9237 Ward Pkwy Ste 240 Kansas City MO 64114-3330 Ph: (816) 799-7996 |
| NPI Number | 1487229530 |
|---|---|
| Provider Enumeration Date | 05/21/2021 |
| Last Update Date | 09/23/2021 |
| Certification Date | 07/27/2021 |
| Medicare PECOS PAC ID | 6507260866 |
|---|---|
| Medicare Enrollment ID | O20210809001551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487229530 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Theresa Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609267806 PECOS PAC ID: 9739461575 Enrollment ID: I20170131001078 |
| Provider Name | Rosemarie A Romain Tyson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780697086 PECOS PAC ID: 4688715949 Enrollment ID: I20170306000086 |
| Provider Name | Roopa Patel Mokha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376992479 PECOS PAC ID: 9032467493 Enrollment ID: I20180801003878 |
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