Healthcare Provider Details

I. General information

NPI: 1902313992
Provider Name (Legal Business Name): SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 E WHITE OAK LN
MARENGO IN
47140-8413
US

IV. Provider business mailing address

PO BOX 270
PAOLI IN
47454-0270
US

V. Phone/Fax

Practice location:
  • Phone: 812-365-3221
  • Fax: 812-365-9502
Mailing address:
  • Phone: 812-723-7118
  • Fax: 812-723-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateIN

VIII. Authorized Official

Name: NANCY RADCLIFF
Title or Position: CEO
Credential:
Phone: 812-723-7118