Healthcare Provider Details

I. General information

NPI: 1407566631
Provider Name (Legal Business Name): SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 LINCOLN AVE
BEDFORD IN
47421-2142
US

IV. Provider business mailing address

PO BOX 270
PAOLI IN
47454-0270
US

V. Phone/Fax

Practice location:
  • Phone: 812-675-4470
  • Fax: 812-675-4469
Mailing address:
  • Phone: 812-723-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: NANCY RADCLIFF
Title or Position: CEO
Credential:
Phone: 812-723-3944