Healthcare Provider Details

I. General information

NPI: 1710968367
Provider Name (Legal Business Name): SOUTHERN INDIANA FAMILY PRACTICE & OBSTETRICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 995
LINTON IN
47441-9496
US

IV. Provider business mailing address

RR 1 BOX 995
LINTON IN
47441-9496
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-7005
  • Fax:
Mailing address:
  • Phone: 812-847-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001987A
License Number StateIN

VIII. Authorized Official

Name: KRISTA L SEXTON-COX
Title or Position: PRESIDENT
Credential: D.O
Phone: 812-847-7005