Provider Demographics
NPI:1093901910
Name:BOARD OF TRUSTEES OF WELBORN CLINIC
Entity Type:Organization
Organization Name:BOARD OF TRUSTEES OF WELBORN CLINIC
Other - Org Name:WELBORN CLINIC GATEWAY DEACONESS RILEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHRISTESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-426-9506
Mailing Address - Street 1:4133 GATEWAY BLVD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4133 GATEWAY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8950
Practice Address - Country:US
Practice Address - Phone:812-426-9459
Practice Address - Fax:812-463-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty