| Roxane S. Bremen, D.o., P.c. | |
|
622 Sw 3rd St Ste B Lees Summit MO 64063-2280 | |
| (816) 398-7048 | |
| (913) 562-9972 |
| Full Name | Roxane S. Bremen, D.o., P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 622 Sw 3rd St, Lees Summit, Missouri |
| Authorized Official Name and Position | Roxane Bremen (PRESIDENT) |
| Authorized Official Contact | 8163987048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roxane S. Bremen, D.o., P.c. 622 Sw 3rd St Suite B Lees Summit MO 64063-2280 Ph: (816) 398-7048 | Roxane S. Bremen, D.o., P.c. 622 Sw 3rd St Ste B Lees Summit MO 64063-2280 Ph: (816) 398-7048 |
| NPI Number | 1619203874 |
|---|---|
| Provider Enumeration Date | 10/22/2009 |
| Last Update Date | 11/22/2011 |
| Medicare PECOS PAC ID | 8123155355 |
|---|---|
| Medicare Enrollment ID | O20100420001007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619203874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 105058 (Missouri) | Primary |
| Provider Name | Roxane S Bremen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033195540 PECOS PAC ID: 5890609994 Enrollment ID: I20100420001039 |
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