Provider Demographics
NPI:1245408103
Name:HILTON HEAD PSYCHIATRIC CLINICS, PC
Entity Type:Organization
Organization Name:HILTON HEAD PSYCHIATRIC CLINICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:PRAKASH
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-681-1935
Mailing Address - Street 1:60 MAIN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6602
Mailing Address - Country:US
Mailing Address - Phone:843-681-1935
Mailing Address - Fax:843-681-7546
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:SUITE H
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6602
Practice Address - Country:US
Practice Address - Phone:843-681-1935
Practice Address - Fax:843-681-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7637Medicare PIN