Provider Demographics
NPI:1407829674
Name:HOOSIER PSYCHIATRY, PC
Entity Type:Organization
Organization Name:HOOSIER PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-323-8226
Mailing Address - Street 1:101 W KIRKWOOD AVE
Mailing Address - Street 2:STE. 103
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6129
Mailing Address - Country:US
Mailing Address - Phone:812-323-8226
Mailing Address - Fax:812-323-8422
Practice Address - Street 1:101 W KIRKWOOD AVE
Practice Address - Street 2:STE. 103
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6129
Practice Address - Country:US
Practice Address - Phone:812-323-8226
Practice Address - Fax:812-323-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010473492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217010Medicare ID - Type Unspecified