| Trauma Recovery Services, Inc. | |
|
10925 Antioch Rd Ste 103 Overland Park KS 66210-2119 | |
| (913) 469-6069 | |
| (913) 469-0604 |
| Full Name | Trauma Recovery Services, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 10925 Antioch Rd Ste 103, Overland Park, Kansas |
| Authorized Official Name and Position | John L. Nieters (OWNER) |
| Authorized Official Contact | 9134696069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trauma Recovery Services, Inc. 10925 Antioch Rd Ste 103 Overland Park KS 66210-2119 Ph: (913) 469-6069 | Trauma Recovery Services, Inc. 10925 Antioch Rd Ste 103 Overland Park KS 66210-2119 Ph: (913) 469-6069 |
| NPI Number | 1316210982 |
|---|---|
| Provider Enumeration Date | 02/13/2012 |
| Last Update Date | 02/13/2012 |
| Medicare PECOS PAC ID | 9335304963 |
|---|---|
| Medicare Enrollment ID | O20120706000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316210982 | NPI | - | NPPES |
| 100240310A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP-377 (Kansas) | Primary |
| Provider Name | John L Nieters |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053334623 PECOS PAC ID: 1557528585 Enrollment ID: I20120202000840 |
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