| Psychiatric Intervention Medical Associates Inc. | |
|
7700 Folsom Blvd Sacramento CA 95826 | |
| (916) 386-3645 | |
| (916) 386-3050 |
| Full Name | Psychiatric Intervention Medical Associates Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7700 Folsom Blvd, Sacramento, California |
| Authorized Official Name and Position | Theodore Avram Goodman (PRESIDENT) |
| Authorized Official Contact | 9163863645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Intervention Medical Associates Inc. 7700 Folsom Blvd Sacramento CA 95826 Ph: (916) 386-3645 | Psychiatric Intervention Medical Associates Inc. 7700 Folsom Blvd Sacramento CA 95826 Ph: (916) 386-3645 |
| NPI Number | 1174618748 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 10/02/2007 |
| Medicare PECOS PAC ID | 3870497910 |
|---|---|
| Medicare Enrollment ID | O20031120001006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174618748 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G35973 (California) | Primary |
| Provider Name | Robert L Blanco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619065513 PECOS PAC ID: 1052215191 Enrollment ID: I20031120001010 |
| Provider Name | Theodore A Goodman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841386471 PECOS PAC ID: 5597676064 Enrollment ID: I20111215000340 |
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