MEDICARE: PREMIER PSYCHIATRIC SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G66328	CA

General Provider Information

NPI Number	:	1932556081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PSYCHIATRIC SERVICES, INC

Provider Business Mailing Address
First Line	:	833 ROYAL TROON PL
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7689
Country	:	US
Telephone Number	:	916-294-7062
Fax Number	:	916-774-6754

Provider Business Practice Location Address
First Line	:	8775 SIERRA COLLEGE BLVD
Second Line	:	SUITE #200
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-5923
Country	:	US
Telephone Number	:	916-294-7062
Fax Number	:	916-490-3697

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MITCHELL GALERKIN
Credential	:	M.D.
Telephone Number	:	916-294-7062

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	02/16/2017

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