Healthcare Provider Details

I. General information

NPI: 1811317977
Provider Name (Legal Business Name): MSO CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 MARY SHERMAN DR
SULLIVAN IN
47882-7633
US

IV. Provider business mailing address

PO BOX 230
SULLIVAN IN
47882-0230
US

V. Phone/Fax

Practice location:
  • Phone: 812-268-3318
  • Fax: 812-268-4017
Mailing address:
  • Phone: 812-268-3318
  • Fax: 812-268-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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