Healthcare Provider Details

I. General information

NPI: 1124072137
Provider Name (Legal Business Name): RISING SUN MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 6TH ST
RISING SUN IN
47040-1114
US

IV. Provider business mailing address

PO BOX 639352
CINCINNATI OH
45263-9352
US

V. Phone/Fax

Practice location:
  • Phone: 812-438-2555
  • Fax: 812-438-1236
Mailing address:
  • Phone: 812-537-8241
  • Fax: 812-537-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TOM FULLER
Title or Position: PRESIDENT
Credential:
Phone: 812-537-8200