Healthcare Provider Details

I. General information

NPI: 1528107018
Provider Name (Legal Business Name): BOARD OF TRUSTEES OF WELBORN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 WASHINGTON AVE
EVANSVILLE IN
47714-0890
US

IV. Provider business mailing address

4411 WASHINGTON AVE
EVANSVILLE IN
47714-0890
US

V. Phone/Fax

Practice location:
  • Phone: 812-474-7123
  • Fax:
Mailing address:
  • Phone: 812-474-7123
  • 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: DR. DAVID CHRISTESON
Title or Position: CEO
Credential: MD
Phone: 812-426-6626