Healthcare Provider Details

I. General information

NPI: 1285774117
Provider Name (Legal Business Name): VINCENNES ORTHOPAEDIC SURGERY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 BAYOU ST
VINCENNES IN
47591-2731
US

IV. Provider business mailing address

PO BOX 313
VINCENNES IN
47591-0313
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-6972
  • Fax: 812-885-2371
Mailing address:
  • Phone: 812-882-6972
  • Fax: 812-885-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY GLOSSER I
Title or Position: GROUP ADMINISTRATOR
Credential: MS
Phone: 812-882-6972