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General NPI Number Information
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NPI Number | 1407829674
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Entity Type | Organization
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Legal Business Name | HOOSIER PSYCHIATRY, PC
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 W KIRKWOOD AVE STE. 103
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6129
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Country | US
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Telephone | 812-323-8226
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Fax | 812-323-8422
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Provider Business Mailing Address
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Address Line | 101 W KIRKWOOD AVE STE. 103
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6129
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Country | US
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Telephone | 812-323-8226
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Fax | 812-323-8422
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Authorized Official
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Title or Position | OWNER
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Name | CHAD WILLIAM SCHULTHEIS
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Credential | M.D.
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Telephone | 812-323-8226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01047349
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License Number State | IN
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