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General NPI Number Information
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NPI Number | 1962552752
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC ASSOCIATES OF LAKE CITY PA
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 165 SW VISION GLENN
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City | LAKE CITY
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State | FL
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Zip | 32025-1111
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Country | US
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Telephone | 386-755-1800
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Fax | 386-758-8770
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Provider Business Mailing Address
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Address Line | 165 SW VISION GLENN
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City | LAKE CITY
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State | FL
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Zip | 32025-1111
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Country | US
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Telephone | 386-755-1800
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Fax | 386-758-8770
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHILPA U. MHATRE
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Credential |
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Telephone | 386-755-1800
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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 | ME0027561
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License Number State | FL
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