1770775579 NPI number — PSYCHIATRY SUBSPECIALTIES CONSULTANTS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770775579 NPI number — PSYCHIATRY SUBSPECIALTIES CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRY SUBSPECIALTIES CONSULTANTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770775579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1131 N OSSEO RD
Provider Second Line Business Mailing Address:
P.O. BOX 187
Provider Business Mailing Address City Name:
HILLSDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49242-9714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-523-3695
Provider Business Mailing Address Fax Number:
517-523-3311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 E CHICAGO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49036-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-279-0248
Provider Business Practice Location Address Fax Number:
517-278-8901
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTRO-URRUTIA
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-279-0248

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  SL078982 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: FC067134 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC2968 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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