Provider Demographics
NPI:1285018630
Name:AMERICAN TELEPSYCHIATRY, INC.
Entity Type:Organization
Organization Name:AMERICAN TELEPSYCHIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAVKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-376-5577
Mailing Address - Street 1:4650 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-5906
Mailing Address - Country:US
Mailing Address - Phone:414-376-5577
Mailing Address - Fax:414-301-6381
Practice Address - Street 1:5408 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1624
Practice Address - Country:US
Practice Address - Phone:414-376-5577
Practice Address - Fax:414-446-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty