Healthcare Provider Details

I. General information

NPI: 1750656146
Provider Name (Legal Business Name): EMERGENCY MEDICINE OF EASTERN INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REID PKWY
RICHMOND IN
47374-1157
US

IV. Provider business mailing address

1100 REID PKWY
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3144
  • Fax:
Mailing address:
  • Phone: 765-983-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE JOHANNE FARRIS
Title or Position: SECRETARY/TREASURER
Credential: M.D.
Phone: 765-983-3144