Provider Demographics
NPI:1598952251
Name:METROEAST NEUROPSYCHIATRIC SERVICES, P.C.
Entity Type:Organization
Organization Name:METROEAST NEUROPSYCHIATRIC SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:V.
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-397-6300
Mailing Address - Street 1:10111 LINCOLN TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1825
Mailing Address - Country:US
Mailing Address - Phone:618-397-6300
Mailing Address - Fax:618-397-8357
Practice Address - Street 1:10111 LINCOLN TRL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1825
Practice Address - Country:US
Practice Address - Phone:618-397-6300
Practice Address - Fax:618-397-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10734Medicare UPIN