Healthcare Provider Details

I. General information

NPI: 1811075286
Provider Name (Legal Business Name): HUNTINGBURG MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 MEDICAL ARTS DR SUITE 3
HUNTINGBURG IN
47542-9049
US

IV. Provider business mailing address

1706 MEDICAL ARTS DR SUITE 3
HUNTINGBURG IN
47542-9049
US

V. Phone/Fax

Practice location:
  • Phone: 812-683-4900
  • Fax: 812-683-3206
Mailing address:
  • Phone: 812-683-4900
  • Fax: 812-683-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002504
License Number StateIN

VIII. Authorized Official

Name: MS. GWENDA L BRECKLER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 812-683-4900