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General NPI Number Information
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NPI Number | 1770422719
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Entity Type | Organization
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Legal Business Name | PHYSICIAN CORRECTIONAL USA (IN), LLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 3500 N HARLAN AVE
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City | EVANSVILLE
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State | IN
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Zip | 47711-2336
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Country | US
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Telephone | 812-421-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 SE 17TH ST STE 408
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1740
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Country | US
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Telephone | 812-499-3023
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Fax | 207-419-6186
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JAMES RICHARD MARTIN
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Credential | MPSA, CCHP
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Telephone | 812-499-3023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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