Provider Demographics
NPI:1114056710
Name:JEFFREY W. SELBY MD PSC
Entity Type:Organization
Organization Name:JEFFREY W. SELBY MD PSC
Other - Org Name:THE LUNG CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-853-5864
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47629-0249
Mailing Address - Country:US
Mailing Address - Phone:812-853-5864
Mailing Address - Fax:812-853-5610
Practice Address - Street 1:10288 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7952
Practice Address - Country:US
Practice Address - Phone:812-853-5864
Practice Address - Fax:812-853-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35712207RP1001X
IN01027862A207RP1001X
363LA2100X
KY3005907363LA2100X
IN71002793A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200879610Medicaid
KY64754484Medicaid
KY7100026680Medicaid
IN000000307442OtherANTHEM
KY00465Medicare PIN
KYD94991Medicare UPIN
IN210000Medicare PIN