Provider Demographics
NPI:1073695243
Name:DEARBORN COUNTY SURGERY PC
Entity Type:Organization
Organization Name:DEARBORN COUNTY SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KROGER
Authorized Official - Suffix:
Authorized Official - Credentials:ST, CMA
Authorized Official - Phone:812-537-5772
Mailing Address - Street 1:368 BIELBY RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-2774
Mailing Address - Country:US
Mailing Address - Phone:812-537-5772
Mailing Address - Fax:812-537-3936
Practice Address - Street 1:368 BIELBY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1099
Practice Address - Country:US
Practice Address - Phone:812-537-5772
Practice Address - Fax:812-537-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4401214Medicaid
IN100094180Medicaid
OH9303081Medicare PIN
IN100094180Medicaid
TN4401214Medicaid