Provider Demographics
NPI:1487684478
Name:SOUTHERN INDIANA ORTHOPEDIC & SPINE SURGERY, PSC
Entity Type:Organization
Organization Name:SOUTHERN INDIANA ORTHOPEDIC & SPINE SURGERY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-256-0700
Mailing Address - Street 1:817 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1241
Mailing Address - Country:US
Mailing Address - Phone:812-256-0700
Mailing Address - Fax:812-256-0704
Practice Address - Street 1:817 SHORT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-1241
Practice Address - Country:US
Practice Address - Phone:812-256-0700
Practice Address - Fax:812-256-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002610A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN229940Medicare ID - Type Unspecified