Healthcare Provider Details
I. General information
NPI: 1972967149
Provider Name (Legal Business Name): ACCUDOC INC PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1463 W WESTRIDGE PKWY
GREENSBURG IN
47240-3252
US
IV. Provider business mailing address
1463 W WESTRIDGE PKWY
GREENSBURG IN
47240-3252
US
V. Phone/Fax
- Phone: 812-662-9500
- Fax: 812-663-6102
- Phone: 812-662-9500
- Fax: 812-663-6102
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | IN |
VIII. Authorized Official
Name: DR.
TRENT
RAY
AUSTIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 812-932-3224