Provider Demographics
NPI: | 1144590290 |
---|---|
Name: | HOSPITAL PSYCHIARTY PLLC |
Entity Type: | Organization |
Organization Name: | HOSPITAL PSYCHIARTY PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | IBRAHIM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 989-996-0566 |
Mailing Address - Street 1: | 3785 BAY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SAGINAW |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48603-2433 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 989-791-2455 |
Mailing Address - Fax: | 989-791-1392 |
Practice Address - Street 1: | 3353 SILVERWOOD DR |
Practice Address - Street 2: | |
Practice Address - City: | SAGINAW |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48603-2180 |
Practice Address - Country: | US |
Practice Address - Phone: | 989-493-9001 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-01-06 |
Last Update Date: | 2018-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301083191 | 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |