| Telepsychiatry Services | |
|
4050 Coon Rapids Blvd Nw Coon Rapids MN 55433-2522 | |
| (612) 262-1166 | |
| Not Available |
| Full Name | Telepsychiatry Services |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4050 Coon Rapids Blvd Nw, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Dominica Tallarico (COO) |
| Authorized Official Contact | 6122222222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Telepsychiatry Services Po Box 43 Mail Route 10860 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | Telepsychiatry Services 4050 Coon Rapids Blvd Nw Coon Rapids MN 55433-2522 Ph: (612) 262-1166 |
| NPI Number | 1790286193 |
|---|---|
| Provider Enumeration Date | 02/22/2018 |
| Last Update Date | 03/22/2024 |
| Certification Date | 03/22/2024 |
| Medicare PECOS PAC ID | 4587573613 |
|---|---|
| Medicare Enrollment ID | O20191022000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790286193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Jagan Mohan Rao Jakkula |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891924957 PECOS PAC ID: 5193966729 Enrollment ID: I20190627003062 |
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