MEDICARE: VANNARA SAKBUN WOMEN'S CENTER

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	207V00000X	Obstetrics & Gynecology Physician	01043923A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000572988	OTHER	IN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700052982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANNARA SAKBUN WOMEN'S CENTER

Provider Business Mailing Address
First Line	:	611 E SPRINGHILL DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4448
Country	:	US
Telephone Number	:	812-478-9845
Fax Number	:	812-478-2074

Provider Business Practice Location Address
First Line	:	611 E SPRINGHILL DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4448
Country	:	US
Telephone Number	:	812-478-9845
Fax Number	:	812-478-2074

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VANNARA SAKBUN
Credential	:	M.D.
Telephone Number	:	812-478-9845

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	10/07/2008

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