Healthcare Provider Details

I. General information

NPI: 1174772651
Provider Name (Legal Business Name): SOUTHERN INDIANA COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W LONGEST ST
PAOLI IN
47454-8821
US

IV. Provider business mailing address

420 W LONGEST ST PO BOX 270
PAOLI IN
47454-8821
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-3944
  • Fax: 812-723-7991
Mailing address:
  • Phone: 812-723-3944
  • Fax: 812-723-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONYA M JONES
Title or Position: BILLING MANAGER
Credential: CBP
Phone: 812-723-7119