Provider Demographics
NPI:1851550552
Name:WHEAT PYSCHIATRIC CLINIC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WHEAT PYSCHIATRIC CLINIC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHEAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-356-0220
Mailing Address - Street 1:242B KEYSER AVE
Mailing Address - Street 2:SUITE 163
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5102
Mailing Address - Country:US
Mailing Address - Phone:318-356-0220
Mailing Address - Fax:
Practice Address - Street 1:226 SOUTH DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5041
Practice Address - Country:US
Practice Address - Phone:318-356-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0213802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DH08Medicare PIN