MEDICARE: MSO CLINICS, 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	261QP2300X	Primary Care Clinic/Center

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	:	1881071108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSO CLINICS, INC.

Provider Business Mailing Address
First Line	:	1602 N UPPER 11 STREET
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 N UPPER 11 STREET
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4820
Country	:	US
Telephone Number	:	812-268-4311
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MICHELLE FRANKLIN
Credential	:
Telephone Number	:	812-268-4311

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	09/18/2015

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