| Providence Psychiatric Services Pllc | |
|
86 Timber Creek Dr Ste 3 Cordova TN 38018-4284 | |
| (901) 881-1500 | |
| Not Available |
| Full Name | Providence Psychiatric Services Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 86 Timber Creek Dr Ste 3, Cordova, Tennessee |
| Authorized Official Name and Position | Jason Fu Liusong (PRESIDENT) |
| Authorized Official Contact | 9018811500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Psychiatric Services Pllc 86 Timber Creek Dr Ste 3 Cordova TN 38018-4284 Ph: (901) 881-1500 | Providence Psychiatric Services Pllc 86 Timber Creek Dr Ste 3 Cordova TN 38018-4284 Ph: (901) 881-1500 |
| NPI Number | 1952913345 |
|---|---|
| Provider Enumeration Date | 08/18/2020 |
| Last Update Date | 09/30/2020 |
| Certification Date | 09/30/2020 |
| Medicare PECOS PAC ID | 6305256223 |
|---|---|
| Medicare Enrollment ID | O20201104002651 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952913345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Liusong Fu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124286687 PECOS PAC ID: 0143490334 Enrollment ID: I20110825000458 |
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