Provider Demographics
NPI:1588129365
Name:PSYCHMED INNOVATIVE SOLUTIONS
Entity type:Organization
Organization Name:PSYCHMED INNOVATIVE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANITUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-838-5373
Mailing Address - Street 1:1704 LISBURN DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3348
Mailing Address - Country:US
Mailing Address - Phone:617-838-5373
Mailing Address - Fax:
Practice Address - Street 1:130 S CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3742
Practice Address - Country:US
Practice Address - Phone:972-547-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty