Healthcare Provider Details

I. General information

NPI: 1700909348
Provider Name (Legal Business Name): SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 E WHITE OAK LN
MARENGO IN
47140-8413
US

IV. Provider business mailing address

420 W LONGEST ST PO BOX 270
PAOLI IN
47454-8821
US

V. Phone/Fax

Practice location:
  • Phone: 812-365-3221
  • Fax: 812-365-9502
Mailing address:
  • Phone: 812-723-7119
  • Fax: 812-723-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TONYA M JONES
Title or Position: BILLING MANAGER
Credential: CPB
Phone: 812-723-7119