NPIMap

Organization Active NPI

Psyclinic, LLC

  • Clinic/Center
  • Flowood, MS
National Provider Identifier
1063818508
Registry record updated Nov 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PSYCLINIC, LLC
Practice address
2540 Flowood Dr
Suite a
Flowood, MS 39232-9362
Phone
(601) 939-5993
Fax
(601) 939-5935
NPI assigned
Nov 11, 2014
Last updated
Nov 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sudhaker Madakasira
Title
MD
Phone
(601) 939-5993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

2540 Flowood Dr
Suite a
Flowood, MS 39232-9362

Mailing address

2540 Flowood Dr
Suite a
Flowood, MS 39232-9362
Phone (601) 939-5993

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415664000000",
    "number": "1063818508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 FLOWOOD DR",
            "address_2": "SUITE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329362",
            "telephone_number": "601-939-5993",
            "fax_number": "601-939-5935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 FLOWOOD DR",
            "address_2": "SUITE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329362",
            "telephone_number": "601-939-5993",
            "fax_number": "601-939-5935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-11",
        "last_updated": "2014-11-11",
        "status": "A",
        "authorized_official_last_name": "MADAKASIRA",
        "authorized_official_first_name": "SUDHAKER",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "601-939-5993"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.