Healthcare Provider Details

I. General information

NPI: 1437359775
Provider Name (Legal Business Name): SOUTHERN INDIANA OBGYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 VETERANS DR
NORTH VERNON IN
47265-2602
US

IV. Provider business mailing address

939 VETERANS DR
NORTH VERNON IN
47265-2602
US

V. Phone/Fax

Practice location:
  • Phone: 812-348-6373
  • Fax: 812-376-4125
Mailing address:
  • Phone: 812-348-6373
  • Fax: 812-376-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDY M WINGHAM
Title or Position: BILLING SPECIALIST
Credential:
Phone: 812-348-6373