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General NPI Number Information
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NPI Number | 1669543260
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Entity Type | Organization
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Legal Business Name | WABASH VALLEY INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6898 N COUNTY ROAD 375 W
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City | BRAZIL
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State | IN
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Zip | 47834-7262
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Country | US
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Telephone | 812-448-1701
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Fax |
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Provider Business Mailing Address
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Address Line | 6898 N COUNTY ROAD 375 W
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City | BRAZIL
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State | IN
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Zip | 47834-7262
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Country | US
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Telephone | 812-448-1701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN A BOLINGER
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Credential | D.O.
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Telephone | 812-448-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 02001231
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License Number State | IN
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