Basic Information
| Provider Information | |||||||||
| NPI: | 1245408103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILTON HEAD PSYCHIATRIC CLINICS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 MAIN ST | ||||||||
| Address2: | SUITE H | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299266602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436811935 | ||||||||
| FaxNumber: | 8436817546 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 MAIN ST | ||||||||
| Address2: | SUITE H | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299266602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436811935 | ||||||||
| FaxNumber: | 8436817546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2008 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | SRIVASTAVA | ||||||||
| AuthorizedOfficialFirstName: | RAVINDRA | ||||||||
| AuthorizedOfficialMiddleName: | PRAKASH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8436811935 | ||||||||
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| 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 | 23689 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.