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General NPI Number Information
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NPI Number | 1013418599
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Entity Type | Organization
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Legal Business Name | EAST INDIANA RECOVERY, LLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 1528 NW 5TH ST
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City | RICHMOND
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State | IN
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Zip | 47374-1844
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Country | US
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Telephone | 937-416-5442
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Fax | 765-935-0073
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Provider Business Mailing Address
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Address Line | 117 S DIXIE DR STE 3
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City | VANDALIA
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State | OH
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Zip | 45377-2142
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Country | US
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Telephone | 937-416-5442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL KOLODZIK
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Credential | MD
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Telephone | 937-825-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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