Provider Demographics
NPI:1861526394
Name:NORTHLAND PSYCHIATRIC SPECIALISTS LLC
Entity type:Organization
Organization Name:NORTHLAND PSYCHIATRIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-453-6777
Mailing Address - Street 1:211 NE 54TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4390
Mailing Address - Country:US
Mailing Address - Phone:816-453-6777
Mailing Address - Fax:816-454-3601
Practice Address - Street 1:211 NE 54TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4390
Practice Address - Country:US
Practice Address - Phone:816-453-6777
Practice Address - Fax:816-454-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODF7523OtherMEDICARE RAILROAD
MODF7523OtherMEDICARE RAILROAD