Healthcare Provider Details

I. General information

NPI: 1871860106
Provider Name (Legal Business Name): LADHA PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 NORTHGATE CT SUITE 206
NEW ALBANY IN
47150-6400
US

IV. Provider business mailing address

3605 NORTHGATE CT SUITE 206
NEW ALBANY IN
47150-6400
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-9221
  • Fax: 812-945-7141
Mailing address:
  • Phone: 812-945-9221
  • Fax: 812-945-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: TRESSEA R HARVEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 812-945-9221