Provider Demographics
NPI:1366600231
Name:INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS, INC
Entity type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION, IU HEALTH SIP
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-353-5866
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:812-829-2237
Mailing Address - Fax:812-829-6342
Practice Address - Street 1:9 N CRANE AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1507
Practice Address - Country:US
Practice Address - Phone:812-829-2237
Practice Address - Fax:812-829-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200133950AMedicaid
INCI4187OtherRAILROAD MEDICARE
IN200133950AMedicaid
INCI4187OtherRAILROAD MEDICARE