Healthcare Provider Details

I. General information

NPI: 1063595452
Provider Name (Legal Business Name): JOSE SALVILLA BADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 SPRING ST STE 200
JEFFERSONVILLE IN
47130-4494
US

IV. Provider business mailing address

3901 ZARING MILL CT
LOUISVILLE KY
40241-3035
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8360
  • Fax: 812-288-8375
Mailing address:
  • Phone: 502-426-8924
  • Fax: 812-282-4293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1047589A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number1047589A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: