Provider Demographics
NPI:1538358288
Name:CASSADA PSYCHIATRIC CLINIC PC
Entity type:Organization
Organization Name:CASSADA PSYCHIATRIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:KEA OGDEN
Authorized Official - Last Name:CASSADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-820-6899
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756-0939
Mailing Address - Country:US
Mailing Address - Phone:662-820-6899
Mailing Address - Fax:
Practice Address - Street 1:304 S DEER CREEK DR W
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:MS
Practice Address - Zip Code:38756-3130
Practice Address - Country:US
Practice Address - Phone:662-820-6899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS161122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06907260Medicaid
MS1427032754OtherINDIVIDUAL NPI #
MS227119428BOtherBCBS
MS227119428BOtherBCBS
MS06907260Medicaid