Provider Demographics
NPI:1063415297
Name:PARK VIEW PSYCHIATRIC SERVICES, PSC
Entity type:Organization
Organization Name:PARK VIEW PSYCHIATRIC SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-282-1888
Mailing Address - Street 1:510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3554
Mailing Address - Country:US
Mailing Address - Phone:812-282-1888
Mailing Address - Fax:812-218-9318
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3554
Practice Address - Country:US
Practice Address - Phone:812-282-1888
Practice Address - Fax:812-218-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003891A1041C0700X, 363LP0808X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0676466OtherELLEN KNOX'S KY MEDICARE #
IN160780JOtherKELLY BUTLER'S IN MEDICARE #
IN160780WOtherELLEN KNOX'S IN MEDICARE #
INCG3623OtherMEDICARE RAILROAD
KYCK2274OtherMEDICARE RAILROAD
IN160780QOtherASAD ISMAIL'S IN MEDICARE #
IN160780IOtherSTEVE SHELTON'S IN MEDICARE #
IN160860OtherMEDICARE
KY2444451000OtherPASSPORT ADVANTAGE
KY0676401OtherSTEVE SHELTON'S KY MEDICARE #
KY0676429OtherASAD ISMAIL'S KY MEDICARE #
KY64100142Medicaid
KY0676412OtherKELLY BUTLER'S KY MEDICARE #
50002992OtherPASSPORT HEALTH PLAN GROUP #
KY65927857Medicaid
50010129OtherPASSPORT HEALTH PLAN # FOR ISMAIL
50010173OtherPASSPORT HEALTH PLAN # FOR KNOX
50010499OtherPASSPORT HEALTH PLAN # FOR BUTLER
5002993OtherPASSPORT HEALTH PLAN # FOR SHELTON
IN100386460Medicaid
IN160860OtherMEDICARE
KY6764Medicare PIN
KY0676429OtherASAD ISMAIL'S KY MEDICARE #
KY0676466OtherELLEN KNOX'S KY MEDICARE #
IN160780WOtherELLEN KNOX'S IN MEDICARE #