Provider Demographics
NPI:1457428112
Name:PSYCHIATRIC ASSOCIATES OF NORTHEAST IOWA PC
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF NORTHEAST IOWA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:MUHAMMAD
Authorized Official - Last Name:AKBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-233-3351
Mailing Address - Street 1:146 W DALE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-233-3351
Mailing Address - Fax:319-235-3132
Practice Address - Street 1:146 W DALE ST
Practice Address - Street 2:STE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1901
Practice Address - Country:US
Practice Address - Phone:319-233-3351
Practice Address - Fax:319-235-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA53382OtherBLUE CROSS BLUE SHIELD
IA1144634Medicaid
IA1144634Medicaid