Provider Demographics
NPI:1710766233
Name:MANOR PSYCHIATRY LLC
Entity Type:Organization
Organization Name:MANOR PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-847-5534
Mailing Address - Street 1:2200 N A W GRIMES BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2745
Mailing Address - Country:US
Mailing Address - Phone:316-847-5534
Mailing Address - Fax:
Practice Address - Street 1:2200 N A W GRIMES BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2745
Practice Address - Country:US
Practice Address - Phone:316-847-5534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty