MEDICARE: SOUTHERN INDIANA OBGYN

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	207VX0000X	Obstetrics Physician

General Provider Information

NPI Number	:	1437359775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN INDIANA OBGYN

Provider Business Mailing Address
First Line	:	939 VETERANS DR
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-2602
Country	:	US
Telephone Number	:	812-348-6373
Fax Number	:	812-376-4125

Provider Business Practice Location Address
First Line	:	939 VETERANS DR
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-2602
Country	:	US
Telephone Number	:	812-348-6373
Fax Number	:	812-376-4125

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	MRS. JUDY M WINGHAM
Credential	:
Telephone Number	:	812-348-6373

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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Directions to “SOUTHERN INDIANA OBGYN ” Practice Location

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