Provider Demographics
NPI:1710161757
Name:CEDARS PSYCHIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:CEDARS PSYCHIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-9153
Mailing Address - Street 1:P.O. BOX 849722
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9722
Mailing Address - Country:US
Mailing Address - Phone:931-528-9153
Mailing Address - Fax:713-877-0970
Practice Address - Street 1:217 NORTH CEDAR AVENUE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2418
Practice Address - Country:US
Practice Address - Phone:931-528-9153
Practice Address - Fax:713-877-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027181103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3096281Medicare PIN
TN3374755Medicare PIN