1902313992 NPI number — SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902313992 NPI number — SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902313992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47454-0270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-723-7118
Provider Business Mailing Address Fax Number:
812-723-7110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5604 E WHITE OAK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARENGO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47140-8413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-365-3221
Provider Business Practice Location Address Fax Number:
812-365-9502
Provider Enumeration Date:
12/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RADCLIFF
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
812-723-7118

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200122740A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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