MEDICARE: INTEGRATED PSYCHIATRY PLLC

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	:	1639840606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 855
Second Line	:
City	:	ANKENY
State	:	IA
Zip	:	50021-0855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 NW 138TH ST
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8377
Country	:	US
Telephone Number	:	515-758-8300
Fax Number	:	515-758-8600

Authorized Official
Title or Position	:	ARNP PM HNP BC
Name	:	PATRICIA FERLITSCH
Credential	:
Telephone Number	:	515-758-8300

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	11/17/2021

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