Provider Demographics
NPI:1295049492
Name:OLEKSANDR OSIPCHUK MD PHD PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:OLEKSANDR OSIPCHUK MD PHD PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIPCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:615-444-3836
Mailing Address - Street 1:1424 W BADDOUR PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2685
Mailing Address - Country:US
Mailing Address - Phone:615-444-3836
Mailing Address - Fax:
Practice Address - Street 1:1424 W BADDOUR PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2685
Practice Address - Country:US
Practice Address - Phone:615-444-3836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN459372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400004066Medicare UPIN
TN103G266716Medicare UPIN