Healthcare Provider Details

I. General information

NPI: 1336433010
Provider Name (Legal Business Name): JACOB MATTHEW RINGENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 ACADEMY AVE
GREENWOOD SC
29646-3869
US

IV. Provider business mailing address

406 N 1ST ST
VINCENNES IN
47591-1340
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4865
  • Fax: 864-725-4883
Mailing address:
  • Phone: 812-882-1106
  • Fax: 812-885-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01075633A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01075633A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33564
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: