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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 Specialty Code Provider Type

Preferred Provider Organization

305R00000X
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for SOUTHERN INDIANA FAMILY PRACTICE CENTER PC

NPI # 1770626152
LBN Legal business name SOUTHERN INDIANA FAMILY PRACTICE CENTER PC
Authorized official KAREN REID-RENNER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/15/2007
Last updated 11/20/2015 - About 11 years ago
Identifiers
IN License # 01055670A
IN License # 71002130A
IN Medicaid 200367600A
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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