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General NPI Number Information
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NPI Number | 1346588134
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Entity Type | Organization
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Legal Business Name | OBASEKI INDIANA FAMILY HEALTH CLINIC, PROF. CORP.
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 645 CANAL ST
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City | EVANSVILLE
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State | IN
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Zip | 47713-2441
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Country | US
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Telephone | 812-491-8765
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Fax | 812-491-8766
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Provider Business Mailing Address
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Address Line | 645 CANAL ST
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City | EVANSVILLE
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State | IN
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Zip | 47713-2441
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Country | US
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Telephone | 812-491-8765
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Fax | 812-491-8766
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Authorized Official
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Title or Position | PRESIDENT
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Name | ART O OBASEKI
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Credential | NP
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Telephone | 812-491-8765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 01039780A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 71000903A
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License Number State | IN
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