Provider Demographics
NPI:1134114622
Name:CARDIOVASCULAR CONSULTANTS OF VINCENNES, PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF VINCENNES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-885-8020
Mailing Address - Street 1:514 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2709
Mailing Address - Country:US
Mailing Address - Phone:812-885-8020
Mailing Address - Fax:812-885-8024
Practice Address - Street 1:514 S 9TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2709
Practice Address - Country:US
Practice Address - Phone:812-885-8020
Practice Address - Fax:812-885-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL978540Medicare PIN
IN443520Medicare ID - Type UnspecifiedMEDICARE NUMBER