Provider Demographics
NPI:1720360761
Name:UNIVERSITY OF SOUTHERN INDIANA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN INDIANA
Other - Org Name:USI-GLENWOOD COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD, DNP, FNP
Authorized Official - Phone:812-461-5257
Mailing Address - Street 1:PO BOX 5046
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5046
Mailing Address - Country:US
Mailing Address - Phone:812-435-0977
Mailing Address - Fax:
Practice Address - Street 1:901 SWEETSER AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2831
Practice Address - Country:US
Practice Address - Phone:812-435-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X, 363LA2100X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty