Provider Type Icon

SOUTHERN INDIANA FAMILY PRACTICE CENTER PC NPI 1770626152


NPI Information

NPI: 1770626152
Provider Name: SOUTHERN INDIANA FAMILY PRACTICE CENTER PC

Doing Business As: SOUTHERN INDIANA FAMILY PRACTICE CENTER

Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization

CLIA Number: 15D0998905

Address:
3209 W FULLERTON PIKE
STE A
BLOOMINGTON, IN
ZIP 47403
Phone: (812) 339-6744
Get Directions

SOUTHERN INDIANA FAMILY PRACTICE CENTER PC is a preferred provider organization in Bloomington, IN. The provider is 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. SOUTHERN INDIANA FAMILY PRACTICE CENTER PC NPI is 1770626152. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Southern Indiana Family Practice Center.

The provider's business location address is:

3209 W FULLERTON PIKE
STE A
BLOOMINGTON, IN
ZIP 47403-060
Phone: (812) 339-6744
Fax: (812) 671-9113

The provider's authorized official is Karen L. Reid-renner .
The authorized official title is Owner and has the following contact phone number (812) 339-6744.

The CLIA number assigned to this NPI record is 15D0998905 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2007 and was last updated on 11/20/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse Practitioner71002130AINDIANANo
2305R00000XPreferred Provider Organization01055670AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1G99934MEDICARE UPININDIANA
2188690MEDICARE ID-TYPE UNSPECIFIEDINDIANA
3200367600AMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.