Provider Demographics
NPI:1033317169
Name:ANN B. PATTERSON MD, PC
Entity Type:Organization
Organization Name:ANN B. PATTERSON MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-634-6646
Mailing Address - Street 1:721 W 13TH ST
Mailing Address - Street 2:STE 322
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1855
Mailing Address - Country:US
Mailing Address - Phone:812-634-6646
Mailing Address - Fax:812-634-2104
Practice Address - Street 1:721 W 13TH ST
Practice Address - Street 2:STE 322
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1855
Practice Address - Country:US
Practice Address - Phone:812-634-6646
Practice Address - Fax:812-634-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047312A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381262OtherBCBS PIN NUMBER
IN000000381262OtherBCBS PIN NUMBER
ING96816Medicare UPIN