Provider Demographics
NPI:1144388984
Name:KENNETH E BOBB MD PC
Entity Type:Organization
Organization Name:KENNETH E BOBB MD PC
Other - Org Name:CARING FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-522-1222
Mailing Address - Street 1:410 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2332
Mailing Address - Country:US
Mailing Address - Phone:812-522-1222
Mailing Address - Fax:812-522-1558
Practice Address - Street 1:410 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2332
Practice Address - Country:US
Practice Address - Phone:812-522-1222
Practice Address - Fax:812-522-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN380620Medicare ID - Type Unspecified