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General NPI Number Information
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NPI Number | 1184292054
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Entity Type | Organization
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Legal Business Name | VIKING PSYCHIATRY LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 9025 COLDWATER RD STE 100
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City | FORT WAYNE
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State | IN
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Zip | 46825-2071
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Country | US
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Telephone | 260-459-9225
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Fax | 260-800-1512
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Provider Business Mailing Address
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Address Line | 9025 COLDWATER RD STE 100
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City | FORT WAYNE
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State | IN
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Zip | 46825-2071
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Country | US
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Telephone | 260-459-9225
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Fax | 260-800-1512
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Authorized Official
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Title or Position | OWNER
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Name | SEAN GODDARD
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Credential | NP
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Telephone | 260-459-9225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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