Provider Demographics
NPI:1265631881
Name:BROWN COUNTY HEALTH SUPPORT CLINIC
Entity Type:Organization
Organization Name:BROWN COUNTY HEALTH SUPPORT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:812-988-6678
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-0893
Mailing Address - Country:US
Mailing Address - Phone:812-988-6678
Mailing Address - Fax:812-988-1599
Practice Address - Street 1:2455 STATE ROAD 46 EAST
Practice Address - Street 2:BUILDING F SUITE 53
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448
Practice Address - Country:US
Practice Address - Phone:812-988-6678
Practice Address - Fax:812-988-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000687B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0905400OtherMEDICARE
INP09223Medicare UPIN