| Psychiatric Services P C | |
|
800 Broadway Ste 208 Fort Wayne IN 46802-2149 | |
| (260) 425-3204 | |
| (260) 425-3206 |
| Full Name | Psychiatric Services P C |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 800 Broadway, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mahender Reddy Surakanti (M.D.) |
| Authorized Official Contact | 2604253204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Services P C Po Box 40139 Fort Wayne IN 46804-0139 Ph: (260) 425-3204 | Psychiatric Services P C 800 Broadway Ste 208 Fort Wayne IN 46802-2149 Ph: (260) 425-3204 |
| NPI Number | 1194913228 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 02/05/2010 |
| Medicare PECOS PAC ID | 8628124567 |
|---|---|
| Medicare Enrollment ID | O20090918000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194913228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 01057700A (Indiana) | Primary |
| Provider Name | Mahender R Surakanti |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417940909 PECOS PAC ID: 7911981030 Enrollment ID: I20040616000686 |
| Provider Name | Mary Ann La Rocque |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851309876 PECOS PAC ID: 4880661982 Enrollment ID: I20040916000442 |
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