NPIMap

Organization Active NPI

Icare Primary Care Clinic, LLC

  • Substance Abuse Rehabilitation Facility
  • Liberty, MO
National Provider Identifier
1699173757
Registry record updated Dec 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
FL001411027 Issued in MO
Legal business name
ICARE PRIMARY CARE CLINIC, LLC
Practice address
550 Rush Creek Pkwy
Suite B
Liberty, MO 64068-9608
Phone
(816) 875-4325
Fax
(636) 237-8053
NPI assigned
Dec 5, 2014
Last updated
Dec 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Erik Christian Petersen, D.O.
Title
Chief Medical Officer
Phone
(816) 875-4325

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X FL001411027 MO Primary

Addresses

Primary practice location

550 Rush Creek Pkwy
Suite B
Liberty, MO 64068-9608

Mailing address

550 Rush Creek Pkwy
Suite B
Liberty, MO 64068-9608
Phone (816) 875-4325

National Provider Directory

National Provider Directory
Tax ID family
Icare Addiction Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1699173757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 RUSH CREEK PKWY",
            "address_2": "SUITE B",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689608",
            "telephone_number": "816-875-4325",
            "fax_number": "636-237-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 RUSH CREEK PKWY",
            "address_2": "SUITE B",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689608",
            "telephone_number": "816-875-4325",
            "fax_number": "636-237-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE PRIMARY CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-05",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "ERIK",
        "authorized_official_middle_name": "CHRISTIAN",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "816-875-4325",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MO",
            "license": "FL001411027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.