MEDICARE: SOUTHERN INDIANA PEDIATRICS P.S.C.

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	208000000X	Pediatrics Physician	50002306A	IN

General Provider Information

NPI Number	:	1811043854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN INDIANA PEDIATRICS P.S.C.

Provider Business Mailing Address
First Line	:	1701 SPRING ST
Second Line	:	SUITE A.
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-2930
Country	:	US
Telephone Number	:	812-282-1367
Fax Number	:	812-284-8377

Provider Business Practice Location Address
First Line	:	1701 SPRING ST
Second Line	:	SUITE A.
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-2930
Country	:	US
Telephone Number	:	812-282-1367
Fax Number	:	812-284-8377

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNN R GULLEY
Credential	:	M.D.
Telephone Number	:	812-282-1367

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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Directions to “SOUTHERN INDIANA PEDIATRICS P.S.C. ” Practice Location

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