1487872636 NPI number — PARK VIEW PSYCHIATRIC SERVICES, PSC

Table of content: (NPI 1487872636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487872636 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:
1487872636
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 STREET
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-282-1888
Provider Business Mailing Address Fax Number:
812-285-8392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 SPRING STREET
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
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:
812-285-8392
Provider Enumeration Date:
04/23/2007

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: 363LP0808X , with the licence number:  50003891A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5002992 . This is a "PASSPORT HEALTH PLAN GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100113670 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: K005430 . This is a "M BLUNK MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000303817 . This is a "JAN BRASHEAR'S ANTHEM #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000640353 . This is a "ANTHEM # FOR BILL COLLINS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200977990 . This is a "K DAVIS MEDICAID NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 78903689 . This is a "MEDICAID GROUP FOR ARNP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000385875 . This is a "AUDRA SUMMERS ANTHEM #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00455002 . This is a "BRASHEAR RR MEDICARE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1952304040 . This is a "JANICE BRASHEAR ARNP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000056294 . This is a "ANTHEM GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100386460 . This is a "MEDICAID GROUP" 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: 50002994 . This is a "PASSPORT HEALTH PLAN # FOR JAN BRASHEAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50704000 . This is a "MAGELLAN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1255390274 . This is a "AUDRA SUMMERS NPI #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00065495 . This is a "BRASHEAR RR MEDICARE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0676472 . This is a "K DAVIS MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50010459 . This is a "PASSORT HEALTH PLAN # FOR SUMMERS" identifier . This identifiers is of the category "OTHER".




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