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General NPI Number Information
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NPI Number | 1205891744
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Entity Type | Individual
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Provider Name | AGNES C BACALA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 12546 E US HIGHWAY 50
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City | LOOGOOTEE
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State | IN
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Zip | 47553-5220
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Country | US
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Telephone | 812-295-5095
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Fax | 812-295-9403
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Provider Business Mailing Address
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Address Line | PO BOX 760
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City | WASHINGTON
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State | IN
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Zip | 47501-0760
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Country | US
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Telephone | 812-254-2760
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Fax | 812-254-8636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32413
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01043434A
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License Number State | IN
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