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General NPI Number Information
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NPI Number | 1821270158
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERNAL MEDICINE OF SOUTHERN INDIANA
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 110 S NEW ALBANY AVE
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City | SELLERSBURG
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State | IN
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Zip | 47172-1540
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Country | US
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Telephone | 812-248-9350
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Fax | 812-248-9351
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Provider Business Mailing Address
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Address Line | 110 S NEW ALBANY AVE
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City | SELLERSBURG
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State | IN
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Zip | 47172-1540
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Country | US
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Telephone | 812-248-9350
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Fax | 812-248-9351
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. ROBERT NEIL ELLIOTT
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Credential | M.D.
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Telephone | 812-248-9350
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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 | 01056931A
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License Number State | IN
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