Provider Demographics
NPI:1568503811
Name:PHYSICIAN ASSOCIATES OF FLOYDS KNOBS, LLC
Entity Type:Organization
Organization Name:PHYSICIAN ASSOCIATES OF FLOYDS KNOBS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:EICHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-923-2273
Mailing Address - Street 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-923-2273
Mailing Address - Fax:812-923-4100
Practice Address - Street 1:800 HIGHLANDER POINT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9465
Practice Address - Country:US
Practice Address - Phone:812-923-2273
Practice Address - Fax:812-923-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100415430Medicaid
IN100415430Medicaid