Provider Demographics
NPI:1184292054
Name:VIKING PSYCHIATRY LLC
Entity type:Organization
Organization Name:VIKING PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:260-459-9225
Mailing Address - Street 1:9025 COLDWATER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2071
Mailing Address - Country:US
Mailing Address - Phone:260-459-9225
Mailing Address - Fax:260-800-1512
Practice Address - Street 1:9025 COLDWATER RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2071
Practice Address - Country:US
Practice Address - Phone:260-459-9225
Practice Address - Fax:260-800-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty