Healthcare Provider Details

I. General information

NPI: 1942143201
Provider Name (Legal Business Name): CW MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S HIGH ST
RISING SUN IN
47040-1124
US

IV. Provider business mailing address

511 S HIGH ST
RISING SUN IN
47040-1124
US

V. Phone/Fax

Practice location:
  • Phone: 812-584-3187
  • Fax:
Mailing address:
  • Phone: 812-584-3187
  • 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: DR. CHRISTOPHER WALCOTT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 815-584-3187