Healthcare Provider Details

I. General information

NPI: 1376723510
Provider Name (Legal Business Name): SOUTHWEST INDIANA PATHOLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY ST
EVANSVILLE IN
47710-1658
US

IV. Provider business mailing address

PO BOX 78
EVANSVILLE IN
47701-0078
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-3344
  • Fax:
Mailing address:
  • Phone: 812-471-1591
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY BOCKELMAN
Title or Position: OWNER
Credential: MD
Phone: 812-450-3344