Provider Demographics
NPI:1831360866
Name:PANACEA PSYCHIATRIC CENTER PLC
Entity type:Organization
Organization Name:PANACEA PSYCHIATRIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:N
Authorized Official - Last Name:HUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-884-5669
Mailing Address - Street 1:5651 FRIST BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2061
Mailing Address - Country:US
Mailing Address - Phone:615-884-5669
Mailing Address - Fax:615-884-5670
Practice Address - Street 1:5651 FRIST BLVD STE 701
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2061
Practice Address - Country:US
Practice Address - Phone:615-884-5669
Practice Address - Fax:615-884-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN413112084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
171089Medicare UPIN