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General NPI Number Information
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NPI Number | 1457332413
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN INDIANA GASTROENTEROLOGY
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2630 22ND ST
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City | COLUMBUS
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State | IN
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Zip | 47201-3702
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Country | US
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Telephone | 812-372-8680
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Fax | 812-372-9265
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Provider Business Mailing Address
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Address Line | 2630 22ND ST
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City | COLUMBUS
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State | IN
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Zip | 47201-3702
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Country | US
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Telephone | 812-372-8680
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Fax | 812-372-9265
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Authorized Official
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Title or Position | PATIENT ACCOUNT REPRESENTATIVE
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Name | DIANE COLE
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Credential | BILLING OFFICE
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Telephone | 812-372-8680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01033813A
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License Number State | IN
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