Healthcare Provider Details

I. General information

NPI: 1013902394
Provider Name (Legal Business Name): SURGICAL ASSOCIATES SOUTHERN INDIANA, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GORDON GUTMANN BLVD SUITE 401
JEFFERSONVILLE IN
47130-3764
US

IV. Provider business mailing address

301 GORDON GUTMANN BLVD SUITE 401
JEFFERSONVILLE IN
47130-3739
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-0637
  • Fax: 812-283-6330
Mailing address:
  • Phone: 812-282-0637
  • Fax: 812-283-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50003241A
License Number StateIN

VIII. Authorized Official

Name: DR. DANIEL C MACMILLAN
Title or Position: PRESIDENT/DIRECTOR
Credential: M.D.
Phone: 812-282-0637