Provider Demographics
NPI:1871773853
Name:ELK GROVE PSYCHIATRIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:ELK GROVE PSYCHIATRIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-525-3434
Mailing Address - Street 1:PO BOX 233977
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-0449
Mailing Address - Country:US
Mailing Address - Phone:916-525-3434
Mailing Address - Fax:916-525-3433
Practice Address - Street 1:8001 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2329
Practice Address - Country:US
Practice Address - Phone:916-200-0329
Practice Address - Fax:916-689-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG717702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G717700Medicare PIN