Provider Demographics
NPI:1689116105
Name:SPRING MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:SPRING MEDICAL CENTER PLLC
Other - Org Name:AAA WEIGHT LOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAWARU
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:OMORUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-725-7187
Mailing Address - Street 1:945 WALL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3620
Mailing Address - Country:US
Mailing Address - Phone:812-725-7187
Mailing Address - Fax:812-777-4492
Practice Address - Street 1:945 WALL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3620
Practice Address - Country:US
Practice Address - Phone:812-725-7187
Practice Address - Fax:812-777-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066757C207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty