Viking Psychiatry Llc | |
9025 Coldwater Rd Ste 100 Fort Wayne IN 46825-2071 | |
(260) 459-9225 | |
(260) 800-1512 |
Full Name | Viking Psychiatry Llc |
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Speciality | Psychiatry & Neurology |
Location | 9025 Coldwater Rd Ste 100, Fort Wayne, Indiana |
Authorized Official Name and Position | Sean Goddard (OWNER) |
Authorized Official Contact | 2604599225 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Viking Psychiatry Llc 9025 Coldwater Rd Ste 100 Fort Wayne IN 46825-2071 Ph: (260) 459-9225 | Viking Psychiatry Llc 9025 Coldwater Rd Ste 100 Fort Wayne IN 46825-2071 Ph: (260) 459-9225 |
NPI Number | 1184292054 |
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Provider Enumeration Date | 06/16/2021 |
Last Update Date | 09/26/2024 |
Certification Date | 09/26/2024 |
Medicare PECOS PAC ID | 4385093350 |
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Medicare Enrollment ID | O20231215002045 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184292054 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | Sean Goddard |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285117143 PECOS PAC ID: 5294088670 Enrollment ID: I20181101001078 |
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