Healthcare Provider Details

I. General information

NPI: 1316682354
Provider Name (Legal Business Name): WESTERN HEALTHCARE SERVICES INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 S MONROE MEDICAL PARK BLVD
BLOOMINGTON IN
47403-8000
US

IV. Provider business mailing address

4932 SUNBEAM RD
JACKSONVILLE FL
32257-6128
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID M DAVIS III
Title or Position: OWNER
Credential:
Phone: 469-364-3333