Healthcare Provider Details

I. General information

NPI: 1073695243
Provider Name (Legal Business Name): DEARBORN COUNTY SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 BIELBY RD SUITE 100
LAWRENCEBURG IN
47025-1099
US

IV. Provider business mailing address

368 BIELBY RD SUITE100
LAWRENCEBURG IN
47025-2774
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-5772
  • Fax: 812-537-3936
Mailing address:
  • Phone: 812-537-5772
  • Fax: 812-537-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BETH A KROGER
Title or Position: PRACTICE MANAGER
Credential: ST, CMA
Phone: 812-537-5772