| Bhg Lxxxiv, Llc | |
|
1125 North 5th Street Obot Room #100 Kansas City KS 66101-2305 | |
| (913) 348-0888 | |
| (913) 342-2644 |
| Full Name | Bhg Lxxxiv, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1125 North 5th Street, Kansas City, Kansas |
| Authorized Official Name and Position | Jay Higham (CEO) |
| Authorized Official Contact | 2143656112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bhg Lxxxiv, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | Bhg Lxxxiv, Llc 1125 North 5th Street Obot Room #100 Kansas City KS 66101-2305 Ph: (913) 348-0888 |
| NPI Number | 1366157059 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/12/2023 |
| Medicare PECOS PAC ID | 7012379506 |
|---|---|
| Medicare Enrollment ID | O20230815003970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366157059 | NPI | - | NPPES |
| Provider Name | Shawn M Stranckmeyer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1558776229 PECOS PAC ID: 4688946064 Enrollment ID: I20190506002063 |
| Provider Name | Alicia Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689604944 PECOS PAC ID: 5395758965 Enrollment ID: I20210126001739 |
| Provider Name | William Carpenter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164787594 PECOS PAC ID: 9032345400 Enrollment ID: I20210930001224 |
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