Provider Demographics
NPI:1558436659
Name:BROWNSTOWN FAMILY MEDICINE,PC
Entity Type:Organization
Organization Name:BROWNSTOWN FAMILY MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-358-2400
Mailing Address - Street 1:806 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-1200
Mailing Address - Country:US
Mailing Address - Phone:812-358-2400
Mailing Address - Fax:
Practice Address - Street 1:806 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-1200
Practice Address - Country:US
Practice Address - Phone:812-358-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN381740Medicare ID - Type Unspecified