Provider Demographics
NPI:1003971193
Name:SOUTHERN INDIANA RESOURCE SOLUTIONS, INC
Entity Type:Organization
Organization Name:SOUTHERN INDIANA RESOURCE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WANINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-897-4840
Mailing Address - Street 1:1579 S FOLSOMVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-9465
Mailing Address - Country:US
Mailing Address - Phone:812-897-4840
Mailing Address - Fax:
Practice Address - Street 1:1012 31ST ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2690
Practice Address - Country:US
Practice Address - Phone:812-547-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN115480OtherDEPT OF HEALTH CSHCS