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General NPI Number Information
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NPI Number | 1760676324
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Entity Type | Organization
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Legal Business Name | NIBEL GENERAL PRACTICE LLC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 1813 WILLOW SUITE 5A
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City | VINCENNES
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State | IN
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Zip | 47591-1064
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Country | US
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Telephone | 812-885-1200
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Fax | 812-885-1209
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Provider Business Mailing Address
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Address Line | 1813 WILLOW SUITE 5A
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City | VINCENNES
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State | IN
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Zip | 47591-1064
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Country | US
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Telephone | 812-885-1200
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Fax | 812-885-1209
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JODY MILES
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Credential |
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Telephone | 812-885-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 01043100A
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License Number State | IN
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