NPIMap

Organization Active NPI

Jeuti B. Wylde, MD PSC

  • Psychiatry Physician
  • Jeffersonville, IN
National Provider Identifier
1497909576
Registry record updated May 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01041261A Issued in IN
Legal business name
JEUTI B. WYLDE, MD PSC
Practice address
1114 E. 10TH St.
Jeffersonville, IN 47130-4227
Phone
(812) 282-2036
Fax
(812) 282-2277
NPI assigned
Nov 16, 2008
Organization subpart
No

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

NPPES NPI Registry

Updated by the provider on May 3, 2010

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

Authorized official

Name
Jeuti B. Wylde, MDNPI 1740285741
Title
Owner/Operator
Phone
(812) 282-2036

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 01041261A IN Primary

Addresses

Primary practice location

1114 E. 10TH St.
Jeffersonville, IN 47130-4227

Mailing address

PO Box 128
Otisco, IN 47163-0128
Phone (812) 282-2036

Other identifiers 1

IdentifierTypeStateIssuer
100362930MedicaidIN

Other names 1

  • Jeffersonville Psychiatric Associates Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1226793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272844800000",
    "number": "1497909576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "OTISCO",
            "state": "IN",
            "postal_code": "471630128",
            "telephone_number": "812-282-2036",
            "fax_number": "812-282-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 E. 10TH ST.",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471304227",
            "telephone_number": "812-282-2036",
            "fax_number": "812-282-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEUTI B. WYLDE, MD PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-16",
        "last_updated": "2010-05-03",
        "status": "A",
        "authorized_official_last_name": "WYLDE",
        "authorized_official_first_name": "JEUTI",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "812-282-2036",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01041261A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100362930",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeffersonville Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; 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.