MEDICARE: SOUTHERN INDIANA COMMUNITY HEALTH CARE, 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)		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841706868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 270
Second Line	:
City	:	PAOLI
State	:	IN
Zip	:	47454-0270
Country	:	US
Telephone Number	:	812-723-7118
Fax Number	:	812-723-7110

Provider Business Practice Location Address
First Line	:	8163 W STATE ROAD 56 STE A
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-7706
Country	:	US
Telephone Number	:	812-936-2425
Fax Number	:	812-936-2599

Authorized Official
Title or Position	:	CEO
Name	:	NANCY RADCLIFF
Credential	:
Telephone Number	:	812-723-7118

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	02/03/2023

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