National Provider Identifier Database

SOUTHERN INDIANA FAMILY PRACTICE CENTER PC
Preferred Provider Organization

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.


Contact Information

SOUTHERN INDIANA FAMILY PRACTICE CENTER PC
3209 W FULLERTON PIKE
STE A
BLOOMINGTON, IN47403-4060
Phone: 812-339-6744
Fax: 812-671-9113
Website:
Specialty Taxonomy Code
* Preferred Provider Organization 305R00000X
Nurse Practitioner 363L00000X

* Indicates primary specialty

NPI Profile & details for SOUTHERN INDIANA FAMILY PRACTICE CENTER PC

NPI Number 1770626152
Legal business name
LBN
SOUTHERN INDIANA FAMILY PRACTICE CENTER PC
Authorized official KAREN REID-RENNER - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 02/15/2007
Last updated 11/20/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • IN License #: 01055670A
  • IN License #: 71002130A
  • IN Medicaid: 200367600A

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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