Provider Demographics
NPI:1174610356
Name:PSYCHIATRIC ASSOCIATES OF PITTSBURG
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF PITTSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:F.A.P.A F.A.A.P.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-232-2270
Mailing Address - Street 1:1011 S MOUNT CARMEL PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6604
Mailing Address - Country:US
Mailing Address - Phone:620-232-2270
Mailing Address - Fax:620-231-1378
Practice Address - Street 1:1011 S MOUNT CARMEL PL
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6604
Practice Address - Country:US
Practice Address - Phone:620-232-2270
Practice Address - Fax:620-231-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-169172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE06738Medicare UPIN
KS016539Medicare ID - Type Unspecified