Healthcare Provider Details

I. General information

NPI: 1841692035
Provider Name (Legal Business Name): SOUTHERN INDIANA COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
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
PAOLI IN
47454-8821
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-3944
  • Fax: 812-723-5292
Mailing address:
  • Phone: 812-723-3944
  • Fax: 812-723-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANA K SCOTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 812-723-3944