Provider Demographics
NPI:1548377401
Name:OTTUMWA PSYCHIATRIC CLINIC PC
Entity type:Organization
Organization Name:OTTUMWA PSYCHIATRIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BERGES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-684-7744
Mailing Address - Street 1:1112 N VAN BUREN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6416
Mailing Address - Country:US
Mailing Address - Phone:641-684-7744
Mailing Address - Fax:641-684-7700
Practice Address - Street 1:1112 N VAN BUREN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6416
Practice Address - Country:US
Practice Address - Phone:641-684-7744
Practice Address - Fax:641-684-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA026592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2776088Medicaid
IA2776088Medicaid
IAE82163Medicare UPIN