Healthcare Provider Details

I. General information

NPI: 1639089550
Provider Name (Legal Business Name): CSJ BRACKETT ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9355 WARRICK TRL
NEWBURGH IN
47630-0015
US

IV. Provider business mailing address

PO BOX 5705
EVANSVILLE IN
47716-5705
US

V. Phone/Fax

Practice location:
  • Phone: 812-492-1960
  • Fax: 812-479-7865
Mailing address:
  • Phone: 812-492-1960
  • Fax: 812-479-7865

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: ERIC BRACKETT
Title or Position: OWNER
Credential: MD
Phone: 812-305-4067