Provider Demographics
NPI:1386345007
Name:PEACE PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:PEACE PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AASTA
Authorized Official - Middle Name:I
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:708-295-1221
Mailing Address - Street 1:609 RIDGE RD # 162
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1609
Mailing Address - Country:US
Mailing Address - Phone:708-951-2212
Mailing Address - Fax:
Practice Address - Street 1:2501 CHATHAM RD STE R
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4188
Practice Address - Country:US
Practice Address - Phone:312-442-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty