| Psychiatric Care And Research Center Inc | |
|
4132 Keaton Crossing Blvd Ste 201 O Fallon MO 63368-8222 | |
| (636) 244-3589 | |
| (636) 244-3594 |
| Full Name | Psychiatric Care And Research Center Inc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4132 Keaton Crossing Blvd, O Fallon, Missouri |
| Authorized Official Name and Position | John P Canale (PRESIDENT) |
| Authorized Official Contact | 6362443589 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Care And Research Center Inc 4132 Keaton Crossing Blvd Ste 201 O Fallon MO 63368-8222 Ph: (636) 244-3589 | Psychiatric Care And Research Center Inc 4132 Keaton Crossing Blvd Ste 201 O Fallon MO 63368-8222 Ph: (636) 244-3589 |
| NPI Number | 1447537071 |
|---|---|
| Provider Enumeration Date | 11/10/2011 |
| Last Update Date | 04/24/2013 |
| Medicare PECOS PAC ID | 3678710506 |
|---|---|
| Medicare Enrollment ID | O20130513000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447537071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| Provider Name | Howard J Ilivicky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093711152 PECOS PAC ID: 0648417576 Enrollment ID: I20130513000277 |
| Provider Name | John P Canale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578569620 PECOS PAC ID: 1850527474 Enrollment ID: I20131203001912 |
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