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General NPI Number Information
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NPI Number | 1225129570
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY ASSOCIATES OF SOUTHERN INDIANA PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1455 W 2ND STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47403
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Country | US
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Telephone | 812-336-6060
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Fax | 812-333-7760
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Provider Business Mailing Address
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Address Line | PO BOX 1148
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City | BLOOMINGTON
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State | IN
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Zip | 47402-1148
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Country | US
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Telephone | 812-336-6060
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Fax | 812-333-7760
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Authorized Official
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Title or Position | PRESIDENT & CHAIR OF GOVERNING BODY
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Name | WILLIAM EDWARD WEBER JR.
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Credential | MD
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Telephone | 812-336-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 50003776A
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License Number State | IN
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