East Texas Psychiatry Associates

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

EAST TEXAS PSYCHIATRY ASSOCIATES

Practice address

22 Bermuda LN
Longview, TX 75605-2902

Phone

(903) 297-6500

Fax

(903) 663-1085

NPI assigned

Jan 4, 2007

Last updated

Sep 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shahrokh Safarimaryaki, M.D.

Title

Owner

Phone

(903) 297-6500

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221782400000",
    "number": "1790832749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5329",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756085329",
            "telephone_number": "903-297-6500",
            "fax_number": "903-663-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BERMUDA LN",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052902",
            "telephone_number": "903-297-6500",
            "fax_number": "903-663-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PSYCHIATRY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-09-19",
        "status": "A",
        "authorized_official_last_name": "SAFARIMARYAKI",
        "authorized_official_first_name": "SHAHROKH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-297-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171015401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0098KZ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Texas Performance Rehabilitation Inc
• East Texas PHC, LLC (Premier HomeCare)
• East Texas Plastic Surgery LLP
• East Texas Primary Care Physicians, PLLC (Primary Care Associates)
• East Texas Prosthetic-Orthotic Care
• East Texas Pulmonary Associates of Longview, PLLC (East Texas Pulmonary Associates)
• East Texas Radiology Consultants
• East Texas Rehabilitation, LLC
• East Texas Sinus and Dizziness Center, PLLC
• East Texas Urology, PLLC

• Child & Adolescent Psychiatry Physician in Longview, TX
• Providers in Longview, TX by specialty
• Child & Adolescent Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; 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.