Provider Demographics
NPI:1568907673
Name:LIFESPRING INC
Entity Type:Organization
Organization Name:LIFESPRING INC
Other - Org Name:SALEM COMMUNITY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP COMMUNITY HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-206-1362
Mailing Address - Street 1:460 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-9730
Practice Address - Country:US
Practice Address - Phone:812-883-3095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPRING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)