Provider Demographics
NPI:1922854728
Name:STAR PSYCHIATRIC SERVICES PC
Entity type:Organization
Organization Name:STAR PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHUTB
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD
Authorized Official - Phone:574-243-0112
Mailing Address - Street 1:239 N DIXIE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3309
Mailing Address - Country:US
Mailing Address - Phone:574-243-0112
Mailing Address - Fax:574-243-0112
Practice Address - Street 1:239 N DIXIE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3309
Practice Address - Country:US
Practice Address - Phone:574-243-0112
Practice Address - Fax:574-243-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit