MEDICARE: LIFESPRING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1205673084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPRING, INC

Provider Business Mailing Address
First Line	:	460 SPRING ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3452
Country	:	US
Telephone Number	:	812-280-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 SOUTH MAIN ST
Second Line	:
City	:	DALE
State	:	IN
Zip	:	47523-5204
Country	:	US
Telephone Number	:	812-280-2080
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PRACTICE MANAGEMENT
Name	:	KRISTIE SWOBODA
Credential	:
Telephone Number	:	812-206-1249

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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Directions to “LIFESPRING, INC ” Practice Location

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