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General NPI Number Information
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NPI Number | 1619068194
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Entity Type | Organization
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Legal Business Name | SOUTHERN INDIANA NEUROLOGY ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1035 WALL ST SUITE 207
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3612
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Country | US
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Telephone | 812-282-1351
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Fax | 812-283-5758
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Provider Business Mailing Address
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Address Line | 1035 WALL ST SUITE 207
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3612
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Country | US
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Telephone | 812-282-1351
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Fax | 812-283-5758
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR P. MATIBAG
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Credential | M.D.
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Telephone | 812-282-1351
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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 | 23576
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License Number State | IN
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