Provider Demographics
NPI:1275678799
Name:PRISAT PA
Entity Type:Organization
Organization Name:PRISAT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SATYEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADKAIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-880-8840
Mailing Address - Street 1:PO BOX 24330
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-4330
Mailing Address - Country:US
Mailing Address - Phone:904-880-8840
Mailing Address - Fax:904-880-1994
Practice Address - Street 1:3685 CROWN POINT COURT
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5967
Practice Address - Country:US
Practice Address - Phone:904-880-8840
Practice Address - Fax:904-880-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9023101YM0800X
FLRN9254064103T00000X
FLARNP2101032163WP0808X
FLRN2580702163WP0808X
FLME83139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588629232OtherNPI - MADKAIKER
FL282634OtherMAGELLAN IP - MADKAIKER
FL1134234669OtherNPI - SICKINGER
FL1306867817OtherNPI - FORKER
FLBCBSOther06183
FLK7273Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLE6273BMedicare ID - Type UnspecifiedMEDICARE - MADKAIKER
FLG50475Medicare UPIN
FL1134234669OtherNPI - SICKINGER
FLBCBSOther06183