Provider Demographics
NPI:1598986713
Name:EUGENE C FLETCHER MD LLC
Entity Type:Organization
Organization Name:EUGENE C FLETCHER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-5841
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47151-0317
Mailing Address - Country:US
Mailing Address - Phone:812-948-5841
Mailing Address - Fax:
Practice Address - Street 1:428 VINCENNES ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3054
Practice Address - Country:US
Practice Address - Phone:812-948-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29686207RC0200X, 207RP1001X
IN01046080A207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64296866Medicaid
IN200057650BMedicaid
INDA7406Medicare PIN
IN211800Medicare PIN
KY64296866Medicaid
KYDA7406Medicare PIN