NPIMap

Organization Active NPI

Professional Psychiatric Services, LLC

  • Psychiatry Physician
  • Fort Wayne, IN
National Provider Identifier
1407166077
Registry record updated Feb 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PROFESSIONAL PSYCHIATRIC SERVICES, LLC
Practice address
6203 Constitution Dr
Fort Wayne, IN 46804-1517
Phone
(260) 969-9696
Fax
(260) 969-7979
NPI assigned
Oct 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. S. Christopher Shim, M.D.
Title
President
Phone
(260) 615-1216

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X IN Primary

Addresses

Primary practice location

6203 Constitution Dr
Fort Wayne, IN 46804-1517

Mailing address

11012 W Sycamore Hills Dr
Fort Wayne, IN 46814-9308
Phone (260) 969-9696

National Provider Directory

National Provider Directory

Locations

6203 Constitution Dr
Fort Wayne, IN 46804
Phone (260) 443-5102

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1407166077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11012 W SYCAMORE HILLS DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468149308",
            "telephone_number": "260-969-9696",
            "fax_number": "260-969-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6203 CONSTITUTION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041517",
            "telephone_number": "260-969-9696",
            "fax_number": "260-969-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "S.",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-615-1216",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.