Provider Demographics
NPI:1598841652
Name:OAKLAND CITY FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:OAKLAND CITY FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GEHLHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-749-6187
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:HWY 64 W
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-0266
Practice Address - Country:US
Practice Address - Phone:812-749-6187
Practice Address - Fax:812-749-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200176150AMedicaid
IN282330Medicare ID - Type Unspecified
INCN8803Medicare ID - Type UnspecifiedRR MCARE GROUP #
IN153854Medicare Oscar/Certification
IN200176150AMedicaid