Healthcare Provider Details

I. General information

NPI: 1841706868
Provider Name (Legal Business Name): SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8163 W STATE ROAD 56 STE A
WEST BADEN SPRINGS IN
47469-7706
US

IV. Provider business mailing address

PO BOX 270
PAOLI IN
47454-0270
US

V. Phone/Fax

Practice location:
  • Phone: 812-936-2425
  • Fax: 812-936-2599
Mailing address:
  • Phone: 812-723-7118
  • Fax: 812-723-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateIN

VIII. Authorized Official

Name: NANCY RADCLIFF
Title or Position: CEO
Credential:
Phone: 812-723-7118