Healthcare Provider Details

I. General information

NPI: 1114056710
Provider Name (Legal Business Name): JEFFREY W. SELBY MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10288 W STATE ROUTE 66
NEWBURGH IN
47630-7952
US

IV. Provider business mailing address

PO BOX 249
NEWBURGH IN
47629-0249
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-5864
  • Fax: 812-853-5610
Mailing address:
  • Phone: 812-853-5864
  • Fax: 812-853-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3005907
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71002793A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01027862A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35712
License Number StateKY

VIII. Authorized Official

Name: DR. JEFFREY W SELBY
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 812-853-5864