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NPI Code Detail

MEDICARE: SOUTHWEST INDIANA PATHOLOGISTS, LLC

MEDICARE: SOUTHWEST INDIANA PATHOLOGISTS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number : 1376723510
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWEST INDIANA PATHOLOGISTS, LLC
Provider Business Mailing Address
First Line : PO BOX 78
Second Line :
City : EVANSVILLE
State : IN
Zip : 47701-0078
Country : US
Telephone Number : 812-471-1591
Fax Number : 812-471-6650
Provider Business Practice Location Address
First Line : 600 MARY ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47710-1658
Country : US
Telephone Number : 812-450-3344
Fax Number :
Authorized Official
Title or Position : OWNER
Name : HENRY BOCKELMAN
Credential : MD
Telephone Number : 812-450-3344
Provider Enumeration Date : 11/05/2007
Last Update Date : 11/05/2007

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