Healthcare Provider Details

I. General information

NPI: 1275827784
Provider Name (Legal Business Name): FMMG HARRISON FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 FEDERAL DR NW SUITE 200
CORYDON IN
47112-3070
US

IV. Provider business mailing address

313 FEDERAL DR NW SUITE 200
CORYDON IN
47112-3070
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4155
  • Fax: 812-738-6104
Mailing address:
  • Phone: 812-738-4155
  • Fax: 812-738-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL EICHENBERGER
Title or Position: PRESIDENT / CEO
Credential:
Phone: 812-948-7632