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General NPI Number Information
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NPI Number | 1275865446
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL SPA, L.L.C.
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 1414 E TIPTON ST
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City | SEYMOUR
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State | IN
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Zip | 47274-3533
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Country | US
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Telephone | 812-524-9222
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Fax | 812-524-9777
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Provider Business Mailing Address
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Address Line | 1414 E TIPTON ST
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City | SEYMOUR
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State | IN
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Zip | 47274-3533
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Country | US
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Telephone | 812-524-9222
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Fax | 812-524-9777
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN PALMER SNOOK
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Credential | M.D.
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Telephone | 812-524-9222
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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 | 01047137
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License Number State | IN
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