Provider Demographics
NPI:1902098957
Name:PSYCHIATRIC SERVICES SC
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HODULIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-238-9354
Mailing Address - Street 1:2727 MARSHALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2255
Mailing Address - Country:US
Mailing Address - Phone:608-238-9354
Mailing Address - Fax:608-238-7675
Practice Address - Street 1:2727 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2255
Practice Address - Country:US
Practice Address - Phone:608-238-9354
Practice Address - Fax:608-238-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1898-057103TC0700X
WI1064-057103TC0700X
WI2284-057103TC0700X
WI2155-057103TC0700X
WI1993-057103TC0700X
WI920-057103TC1900X
WI522-1231041C0700X
WI1085-1231041C0700X
WI3257-1231041C0700X
WI7213-1231041C0700X
WI504-1231041C0700X
WI391-1231041C0700X
WI41061-0212084P0800X
WI22400-0202084P0800X
WI42985-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42141600Medicaid