Provider Demographics
NPI:1033142773
Name:THE DERMATOLOGY CENTER,PSC
Entity Type:Organization
Organization Name:THE DERMATOLOGY CENTER,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BANET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-944-7500
Mailing Address - Street 1:825 UNIVERSITY WOODS DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2427
Mailing Address - Country:US
Mailing Address - Phone:812-944-7500
Mailing Address - Fax:812-944-4656
Practice Address - Street 1:825 UNIVERSITY WOODS DR
Practice Address - Street 2:SUITE 8
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2427
Practice Address - Country:US
Practice Address - Phone:812-944-7500
Practice Address - Fax:812-944-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046423174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200153530AMedicaid
IN200153530AMedicaid
IN207330AMedicare ID - Type Unspecified