| Indiana Psychiatric Associates Llc | |
|
4656 W Jefferson Blvd Ste 201 Fort Wayne IN 46804-6857 | |
| (978) 000-0001 | |
| Not Available |
| Full Name | Indiana Psychiatric Associates Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4656 W Jefferson Blvd Ste 201, Fort Wayne, Indiana |
| Authorized Official Name and Position | Satya Kishore Gutta (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2602089676 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Psychiatric Associates Llc 4656 W Jefferson Blvd Ste 201 Fort Wayne IN 46804-6857 Ph: () - | Indiana Psychiatric Associates Llc 4656 W Jefferson Blvd Ste 201 Fort Wayne IN 46804-6857 Ph: (978) 000-0001 |
| NPI Number | 1942972047 |
|---|---|
| Provider Enumeration Date | 09/28/2021 |
| Last Update Date | 02/18/2022 |
| Certification Date | 02/18/2022 |
| Medicare PECOS PAC ID | 2365834140 |
|---|---|
| Medicare Enrollment ID | O20220128001387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942972047 | NPI | - | NPPES |
| Provider Name | Satya Kishore Gutta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821364498 PECOS PAC ID: 8628396371 Enrollment ID: I20220128001462 |
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