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General NPI Number Information
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NPI Number | 1508875030
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Entity Type | Organization
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Legal Business Name | CHARLESTOWN SURGICAL ASSOCIATES, PSC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2100 MARKET ST SUITE 100
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City | CHARLESTOWN
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State | IN
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Zip | 47111-9535
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Country | US
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Telephone | 812-256-1111
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Fax | 812-256-1112
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Provider Business Mailing Address
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Address Line | 2100 MARKET ST SUITE 100
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City | CHARLESTOWN
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State | IN
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Zip | 47111-9535
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Country | US
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Telephone | 812-256-1111
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Fax | 812-256-1112
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | STEVE EDWARD THOMAS
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Credential | M.D.
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Telephone | 812-256-1111
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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 | 01050752A
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License Number State | IN
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