Provider Demographics
NPI:1174746127
Name:TOTAL FAMILY CARE, PC
Entity type:Organization
Organization Name:TOTAL FAMILY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-479-3834
Mailing Address - Street 1:PO BOX 5225
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5225
Mailing Address - Country:US
Mailing Address - Phone:812-479-3834
Mailing Address - Fax:812-479-3835
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0106
Practice Address - Country:US
Practice Address - Phone:812-479-3834
Practice Address - Fax:812-479-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35496207Q00000X
IN01050887A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000195479OtherBCBS PIN NUMBER
IN180950Medicare ID - Type Unspecified
IN000000195479OtherBCBS PIN NUMBER