MEDICARE: SPRINGFIELD PSYCHIATRIC ASSOCIATES 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	1041C0700X	Clinical Social Worker	I.0002982	OH
2	104100000X	Social Worker	I.0002982	OH
3	2084P0804X	Child & Adolescent Psychiatry Physician	35063060	OH
4	2084P0800X	Psychiatry Physician	35063060	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9341501	OTHER	OH	MEDICARE

General Provider Information

NPI Number	:	1962541375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGFIELD PSYCHIATRIC ASSOCIATES INC

Provider Business Mailing Address
First Line	:	3162 EL CAMINO DR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1318
Country	:	US
Telephone Number	:	937-342-9030
Fax Number	:	937-342-9039

Provider Business Practice Location Address
First Line	:	3162 EL CAMINO DR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1318
Country	:	US
Telephone Number	:	937-342-9030
Fax Number	:	937-342-9039

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PRAMILA VELLANKI
Credential	:
Telephone Number	:	937-342-9030

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/22/2024

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Directions to “SPRINGFIELD PSYCHIATRIC ASSOCIATES INC ” Practice Location

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