Provider Demographics
NPI:1508085754
Name:SOUTHERN INDIANA TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:SOUTHERN INDIANA TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-283-4844
Mailing Address - Street 1:1713 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7100
Mailing Address - Country:US
Mailing Address - Phone:812-283-4844
Mailing Address - Fax:812-283-0056
Practice Address - Street 1:1713 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-7100
Practice Address - Country:US
Practice Address - Phone:812-283-4844
Practice Address - Fax:812-283-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization