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General NPI Number Information
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NPI Number | 1043279813
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Entity Type | Organization
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Legal Business Name | OHIO VALLEY COLON & RECTAL SURGEONS, INC.
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 801 ST. MARY'S DRIVE WEST SUITE 300
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City | EVANSVILLE
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State | IN
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Zip | 47714-0560
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Country | US
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Telephone | 812-477-9241
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Fax | 812-474-6708
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Provider Business Mailing Address
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Address Line | 801 SAINT MARYS DR STE 300 W
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City | EVANSVILLE
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State | IN
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Zip | 47714-0511
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Country | US
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Telephone | 812-477-9241
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Fax | 812-474-6708
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Authorized Official
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Title or Position | VICE-PRESIDENT/SECRETARY
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Name | DR. JAMES D. WALLER JR.
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Credential | M.D.
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Telephone | 812-301-8110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 50002315A
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License Number State | IN
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