Provider Demographics
NPI:1750451993
Name:MID-AMERICA PSYCHIATRIC CONSULTANTS, LLC
Entity Type:Organization
Organization Name:MID-AMERICA PSYCHIATRIC CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-876-7519
Mailing Address - Street 1:2120 MADISON AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040
Mailing Address - Country:US
Mailing Address - Phone:618-876-7515
Mailing Address - Fax:618-876-7596
Practice Address - Street 1:2120 MADISON AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-876-7515
Practice Address - Fax:618-876-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505200402002Medicaid
IL0006030018OtherBLUE CROSS BLUE SHIELD
MO000013362Medicare PIN
IL599900Medicare PIN