Healthcare Provider Details

I. General information

NPI: 1124868740
Provider Name (Legal Business Name): LIFESPRING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S MAPLE ST
ORLEANS IN
47452-1724
US

IV. Provider business mailing address

460 SPRING ST
JEFFERSONVILLE IN
47130-3452
US

V. Phone/Fax

Practice location:
  • Phone: 812-865-3350
  • Fax: 812-206-1243
Mailing address:
  • Phone: 812-280-2080
  • Fax:

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: KRISTIE SWOBODA
Title or Position: PRACTICE MANAGEMENT ADMINISTRATOR
Credential:
Phone: 812-206-1249