Provider Demographics
NPI:1760968689
Name:EAST INDIANA PHYSICIANS ASSOCIATES
Entity Type:Organization
Organization Name:EAST INDIANA PHYSICIANS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-633-5988
Mailing Address - Street 1:4447 WYNFALL CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2948
Mailing Address - Country:US
Mailing Address - Phone:516-633-5988
Mailing Address - Fax:
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-537-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010-77-381A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty