Provider Demographics
NPI:1821270158
Name:ADVANCED INTERNAL MEDICINE OF SOUTHERN INDIANA
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE OF SOUTHERN INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-248-9350
Mailing Address - Street 1:110 S NEW ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1540
Mailing Address - Country:US
Mailing Address - Phone:812-248-9350
Mailing Address - Fax:812-248-9351
Practice Address - Street 1:110 S NEW ALBANY AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1540
Practice Address - Country:US
Practice Address - Phone:812-248-9350
Practice Address - Fax:812-248-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056931A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN218920OtherMEDICARE GROUP NUMBER
IN218920OtherMEDICARE GROUP NUMBER