Provider Demographics
NPI:1376823112
Name:CONVENIENT CARE CLINIC
Entity Type:Organization
Organization Name:CONVENIENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PHYSICIAN SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-885-8972
Mailing Address - Street 1:520 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-885-8972
Mailing Address - Fax:812-885-3773
Practice Address - Street 1:1813 WILLOW ST
Practice Address - Street 2:SUITE 3
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4276
Practice Address - Country:US
Practice Address - Phone:812-885-8941
Practice Address - Fax:812-885-8940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200922190Medicaid
IN258190Medicare UPIN