Provider Demographics
NPI:1710968367
Name:SOUTHERN INDIANA FAMILY PRACTICE & OBSTETRICS P.C.
Entity Type:Organization
Organization Name:SOUTHERN INDIANA FAMILY PRACTICE & OBSTETRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEXTON-COX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-847-7005
Mailing Address - Street 1:RR 1 BOX 995
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9496
Mailing Address - Country:US
Mailing Address - Phone:812-847-7005
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 995
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9496
Practice Address - Country:US
Practice Address - Phone:812-847-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001987A207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200889400Medicaid
IN200243130Medicaid
IN153886Medicare Oscar/Certification
IN171520Medicare PIN