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General NPI Number Information
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NPI Number | 1548357775
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL ASSOCIATES P C
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 1428 N GARDNER ST
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City | SCOTTSBURG
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State | IN
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Zip | 47170-8720
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Country | US
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Telephone | 812-752-4001
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Fax | 812-752-4654
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Provider Business Mailing Address
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Address Line | 1428 N GARDNER ST
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City | SCOTTSBURG
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State | IN
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Zip | 47170-8720
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Country | US
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Telephone | 812-752-4001
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Fax | 812-752-4654
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Authorized Official
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Title or Position | PRESIDENT
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Name | DHAMY SIVAMOHAN
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Credential | M.D.
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Telephone | 812-595-0280
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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 | 01055482A
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License Number State | IN
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