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General NPI Number Information
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NPI Number | 1740517663
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Entity Type | Organization
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Legal Business Name | SOUTHERN METROPOLITAN PSYCHIATRIC CONSULTANTS, LLC
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 8600 EAGLE CREEK PKWY
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City | SAVAGE
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State | MN
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Zip | 55378-1284
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Country | US
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Telephone | 952-454-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 EAGLE CREEK PKWY
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City | SAVAGE
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State | MN
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Zip | 55378-1284
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Country | US
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Telephone | 952-454-2150
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Fax |
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Authorized Official
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Title or Position | STAFF PSYCHIATRIST
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Name | JOHN WERMAGER
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Credential | M.D.
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Telephone | 952-454-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 45638
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License Number State | MN
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