Provider Demographics
NPI:1346334240
Name:PSYCHIATRY SUBSPECIALTIES CONSULTANTS PC
Entity Type:Organization
Organization Name:PSYCHIATRY SUBSPECIALTIES CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO-URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-279-0248
Mailing Address - Street 1:1131 N OSSEO RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9714
Mailing Address - Country:US
Mailing Address - Phone:517-523-3695
Mailing Address - Fax:517-523-3311
Practice Address - Street 1:259 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2046
Practice Address - Country:US
Practice Address - Phone:517-279-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISL0789822084P0804X, 2084P0805X
MIFC0671342084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4653622Medicaid
MI4653631Medicaid
MI260A210220OtherBLUE CROSS BLUE SHIELD
MI4653622Medicaid
MIH80272Medicare UPIN
MIDC2968Medicare ID - Type UnspecifiedRR MEDICARE
MI0N90820Medicare ID - Type Unspecified
MI0N90820Medicare PIN