Provider Demographics
NPI:1437359775
Name:SOUTHERN INDIANA OBGYN
Entity Type:Organization
Organization Name:SOUTHERN INDIANA OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-348-6373
Mailing Address - Street 1:939 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-2602
Mailing Address - Country:US
Mailing Address - Phone:812-348-6373
Mailing Address - Fax:812-376-4125
Practice Address - Street 1:939 VETERANS DR
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-2602
Practice Address - Country:US
Practice Address - Phone:812-348-6373
Practice Address - Fax:812-376-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty