Provider Demographics
NPI:1619142007
Name:C GROUP PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:C GROUP PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUKMINI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILAKAMARRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-849-0450
Mailing Address - Street 1:224 S WOODS MILL RD STE 670S
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3618
Mailing Address - Country:US
Mailing Address - Phone:314-849-0450
Mailing Address - Fax:314-849-0159
Practice Address - Street 1:224 S WOODS MILL RD STE 670S
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3618
Practice Address - Country:US
Practice Address - Phone:314-849-0450
Practice Address - Fax:314-849-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
202428413Medicare PIN
000002914Medicare Oscar/Certification
A10518Medicare UPIN