MEDICARE: VIKING PSYCHIATRY LLC

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

General Provider Information

NPI Number	:	1184292054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIKING PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	9025 COLDWATER RD STE 100
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2071
Country	:	US
Telephone Number	:	260-459-9225
Fax Number	:	260-800-1512

Provider Business Practice Location Address
First Line	:	9025 COLDWATER RD STE 100
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2071
Country	:	US
Telephone Number	:	260-459-9225
Fax Number	:	260-800-1512

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN GODDARD
Credential	:	NP
Telephone Number	:	260-459-9225

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	09/26/2024

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