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General NPI Number Information
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NPI Number | 1699769349
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Entity Type | Organization
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Legal Business Name | NEUROSURGERY OF SOUTHERN INDIANA, LLC
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2326 18TH ST STE 120
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City | COLUMBUS
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State | IN
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Zip | 47201-5359
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Country | US
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Telephone | 812-373-9730
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Fax | 812-373-9734
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Provider Business Mailing Address
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Address Line | 2326 18TH ST STE 120
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City | COLUMBUS
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State | IN
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Zip | 47201-5359
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Country | US
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Telephone | 812-373-9730
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Fax | 812-373-9734
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | PATRICK J CONNOLLY
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Credential | M.D.
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Telephone | 812-373-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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