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3500 S 4th St Leavenworth KS 66048-5043 | |
| (909) 235-4362 | |
| (909) 235-4418 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 3500 S 4th St, Leavenworth, Kansas |
| Authorized Official Name and Position | Luis Leon (PRESIDENT OF OPERATIONS II) |
| Authorized Official Contact | 9092354362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3500 S 4th St Leavenworth KS 66048-5043 Ph: (909) 235-4362 | 3500 S 4th St Leavenworth KS 66048-5043 Ph: (909) 235-4362 |
| NPI Number | 1598108680 |
|---|---|
| Provider Enumeration Date | 04/09/2013 |
| Last Update Date | 07/01/2013 |
| Medicare PECOS PAC ID | 9133364961 |
|---|---|
| Medicare Enrollment ID | O20130328000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598108680 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (Kansas) | Primary |
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