| Metta Bhavana Llc | |
|
330 W Lakeside St Madison WI 53715-2072 | |
| (608) 561-7533 | |
| Not Available |
| Full Name | Metta Bhavana Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 330 W Lakeside St, Madison, Wisconsin |
| Authorized Official Name and Position | Devin James Coogan (OWNDER) |
| Authorized Official Contact | 5052316658 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Metta Bhavana Llc 330 W Lakeside St Madison WI 53715-2072 Ph: (608) 561-7533 | Metta Bhavana Llc 330 W Lakeside St Madison WI 53715-2072 Ph: (608) 561-7533 |
| NPI Number | 1386370476 |
|---|---|
| Provider Enumeration Date | 07/29/2022 |
| Last Update Date | 06/10/2023 |
| Certification Date | 06/10/2023 |
| Medicare PECOS PAC ID | 1557737368 |
|---|---|
| Medicare Enrollment ID | O20221019002614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386370476 | NPI | - | NPPES |
| 1740762327 | Other | WI | NATIONAL PLAN AND PROVIDER SYSTEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Devin James Coogan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740762327 PECOS PAC ID: 2466828272 Enrollment ID: I20221020002300 |
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