Provider Demographics
NPI:1710155544
Name:ARTHUR R BOERNER MD PMC
Entity Type:Organization
Organization Name:ARTHUR R BOERNER MD PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-288-9646
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47131-0770
Mailing Address - Country:US
Mailing Address - Phone:812-288-9646
Mailing Address - Fax:812-283-8391
Practice Address - Street 1:1407 SPRING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3748
Practice Address - Country:US
Practice Address - Phone:812-288-9646
Practice Address - Fax:812-283-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061638A207Q00000X
IN01029076A207V00000X
IN71002263A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200451390BMedicaid
IN200451390BMedicaid