Healthcare Provider Details

I. General information

NPI: 1063831527
Provider Name (Legal Business Name): MSO CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N SECTION ST
SULLIVAN IN
47882-7523
US

IV. Provider business mailing address

PO BOX 10
SULLIVAN IN
47882-0010
US

V. Phone/Fax

Practice location:
  • Phone: 812-268-4311
  • Fax: 812-268-2650
Mailing address:
  • Phone: 812-268-4311
  • Fax: 812-268-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE FRANKLIN
Title or Position: CEO
Credential:
Phone: 812-268-4311