| Star Psychiatric Services Pc | |
|
239 N Dixie Way South Bend IN 46637-3309 | |
| (574) 243-0112 | |
| Not Available |
| Full Name | Star Psychiatric Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 239 N Dixie Way, South Bend, Indiana |
| Authorized Official Name and Position | Khutb Uddin (OWNER) |
| Authorized Official Contact | 5742430112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Star Psychiatric Services Pc 239 N Dixie Way South Bend IN 46637-3309 Ph: (574) 243-0112 | Star Psychiatric Services Pc 239 N Dixie Way South Bend IN 46637-3309 Ph: (574) 243-0112 |
| NPI Number | 1700138492 |
|---|---|
| Provider Enumeration Date | 10/05/2012 |
| Last Update Date | 10/26/2012 |
| Medicare PECOS PAC ID | 4688824550 |
|---|---|
| Medicare Enrollment ID | O20121031000040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700138492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Khutb M Uddin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336234756 PECOS PAC ID: 8022165323 Enrollment ID: I20090402000114 |
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