Provider Demographics
NPI:1982656641
Name:SELBY PHYSICIANS SERVICES INC
Entity Type:Organization
Organization Name:SELBY PHYSICIANS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-568-2040
Mailing Address - Street 1:1106 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1323
Mailing Address - Country:US
Mailing Address - Phone:740-568-2048
Mailing Address - Fax:740-568-2094
Practice Address - Street 1:1106 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1323
Practice Address - Country:US
Practice Address - Phone:740-568-2048
Practice Address - Fax:740-568-2089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELBY PHYSICIAN SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2638435Medicaid