Provider Demographics
NPI:1346239761
Name:J P STULC PSC
Entity Type:Organization
Organization Name:J P STULC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAROSLAV
Authorized Official - Middle Name:P
Authorized Official - Last Name:STULC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-471-1591
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47705-0717
Mailing Address - Country:US
Mailing Address - Phone:812-471-1591
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:444 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:812-471-1591
Practice Address - Fax:812-471-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64283252Medicaid
KY7333Medicare ID - Type Unspecified