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General NPI Number Information
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NPI Number | 1891311791
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL CENTER LLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 5300 STATE ROAD 64 STE 101
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City | GEORGETOWN
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State | IN
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Zip | 47122-9178
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Country | US
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Telephone | 812-590-1600
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Fax | 812-590-6561
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Provider Business Mailing Address
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Address Line | 5300 STATE ROAD 64 STE 101
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City | GEORGETOWN
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State | IN
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Zip | 47122-9178
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Country | US
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Telephone | 812-590-1600
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Fax | 812-590-6561
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. SYED BOKHARI
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Credential |
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Telephone | 812-590-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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