Provider Demographics
NPI:1821282617
Name:BACK CLINIC OF SOUTHERN INDIANA
Entity Type:Organization
Organization Name:BACK CLINIC OF SOUTHERN INDIANA
Other - Org Name:LOUIE N WILLIAMS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-949-5134
Mailing Address - Street 1:1919 STATE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6806
Mailing Address - Country:US
Mailing Address - Phone:812-949-5134
Mailing Address - Fax:812-949-5169
Practice Address - Street 1:1919 STATE ST STE 302
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6806
Practice Address - Country:US
Practice Address - Phone:812-949-5134
Practice Address - Fax:812-949-5169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUIE N WILLIAMS MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041323A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN145290Medicare PIN