Basic Information
| Provider Information | |||||||||
| NPI: | 1134381320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 4 N PSYCH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 576649 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953576649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095718330 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Practice Location | |||||||||
| Address1: | 1878 E HATCH RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953515002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095718330 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2008 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | ADAMSON | ||||||||
| AuthorizedOfficialFirstName: | REX | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2095954937 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G85915 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.