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General NPI Number Information
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NPI Number | 1407166077
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 6203 CONSTITUTION DR
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City | FORT WAYNE
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State | IN
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Zip | 46804-1517
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Country | US
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Telephone | 260-969-9696
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Fax | 260-969-7979
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Provider Business Mailing Address
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Address Line | 11012 W SYCAMORE HILLS DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-9308
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Country | US
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Telephone | 260-969-9696
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Fax | 260-969-7979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. S. CHRISTOPHER SHIM
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Credential | M.D.
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Telephone | 260-615-1216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IN
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