MEDICARE: ORACLE PRIME,LLC

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	213E00000X	Podiatrist	07000624A	IN

General Provider Information

NPI Number	:	1801071402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORACLE PRIME,LLC

Provider Business Mailing Address
First Line	:	201 E MARKET ST
Second Line	:	SUITE 2
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3362
Country	:	US
Telephone Number	:	812-280-0160
Fax Number	:	812-280-0160

Provider Business Practice Location Address
First Line	:	201 E MARKET ST
Second Line	:	SUITE 2
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3362
Country	:	US
Telephone Number	:	812-280-0160
Fax Number	:	812-280-0160

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DENNIS R WILLIAMS
Credential	:	D.P.M.
Telephone Number	:	812-280-0160

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	03/03/2008

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Directions to “ORACLE PRIME,LLC ” Practice Location

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