| NPI | 1770084261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA HENRY Credentialing Specialist 812-590-6936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QU0200X Clinic/Center Urgent Care | |
| 363A00000X Physician Assistant | |
| 261QX0100X Clinic/Center Occupational Medicine | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2018-02-21 |