Healthcare Provider Details

I. General information

NPI: 1225456668
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 16TH ST
BEDFORD IN
47421-3510
US

IV. Provider business mailing address

PO BOX 1329
BLOOMINGTON IN
47402-1329
US

V. Phone/Fax

Practice location:
  • Phone: 812-279-6506
  • Fax:
Mailing address:
  • Phone: 812-353-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CRAIG
Title or Position: CFO
Credential:
Phone: 812-353-9554