1063415297 NPI number — PARK VIEW PSYCHIATRIC SERVICES, PSC

Table of content: (NPI 1063415297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063415297 NPI number — PARK VIEW PSYCHIATRIC SERVICES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARK VIEW PSYCHIATRIC SERVICES, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063415297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-282-1888
Provider Business Mailing Address Fax Number:
812-218-9318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-282-1888
Provider Business Practice Location Address Fax Number:
812-218-9318
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-282-1888

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  50003891A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 50003891A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: 50003891A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0676466 . This is a "ELLEN KNOX'S KY MEDICARE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 160780J . This is a "KELLY BUTLER'S IN MEDICARE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 160780W . This is a "ELLEN KNOX'S IN MEDICARE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CG3623 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CK2274 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 160780Q . This is a "ASAD ISMAIL'S IN MEDICARE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 160780I . This is a "STEVE SHELTON'S IN MEDICARE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 160860 . This is a "MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2444451000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0676401 . This is a "STEVE SHELTON'S KY MEDICARE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0676429 . This is a "ASAD ISMAIL'S KY MEDICARE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64100142 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0676412 . This is a "KELLY BUTLER'S KY MEDICARE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50002992 . This is a "PASSPORT HEALTH PLAN GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65927857 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50010129 . This is a "PASSPORT HEALTH PLAN # FOR ISMAIL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50010173 . This is a "PASSPORT HEALTH PLAN # FOR KNOX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50010499 . This is a "PASSPORT HEALTH PLAN # FOR BUTLER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5002993 . This is a "PASSPORT HEALTH PLAN # FOR SHELTON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100386460 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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