Provider Demographics
NPI:1295561801
Name:COMPASSIONATE PSYCHIATRIC SERVICES OF SOUTHLAKE PA
Entity type:Organization
Organization Name:COMPASSIONATE PSYCHIATRIC SERVICES OF SOUTHLAKE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAZIMUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-750-3053
Mailing Address - Street 1:281 W SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7052
Mailing Address - Country:US
Mailing Address - Phone:469-200-4093
Mailing Address - Fax:469-200-4079
Practice Address - Street 1:281 W SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7052
Practice Address - Country:US
Practice Address - Phone:469-200-4093
Practice Address - Fax:469-200-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty