Healthcare Provider Details

I. General information

NPI: 1487684478
Provider Name (Legal Business Name): SOUTHERN INDIANA ORTHOPEDIC & SPINE SURGERY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 SHORT ST
CHARLESTOWN IN
47111-1241
US

IV. Provider business mailing address

817 SHORT ST
CHARLESTOWN IN
47111-1241
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-0700
  • Fax: 812-256-0704
Mailing address:
  • Phone: 812-256-0700
  • Fax: 812-256-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02002610A
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT J BLOK
Title or Position: PRESIDENT
Credential: DO
Phone: 812-256-0700