Provider Demographics
NPI:1760676324
Name:NIBEL GENERAL PRACTICE LLC
Entity Type:Organization
Organization Name:NIBEL GENERAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-885-1200
Mailing Address - Street 1:1813 WILLOW
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1064
Mailing Address - Country:US
Mailing Address - Phone:812-885-1200
Mailing Address - Fax:812-885-1209
Practice Address - Street 1:1813 WILLOW
Practice Address - Street 2:SUITE 5A
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1064
Practice Address - Country:US
Practice Address - Phone:812-885-1200
Practice Address - Fax:812-885-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043100A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266410Medicare PIN