Provider Demographics
NPI:1871660084
Name:ARTHRITIS ASSOCIATES OF SOUTHERN INDIANA
Entity Type:Organization
Organization Name:ARTHRITIS ASSOCIATES OF SOUTHERN INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EHSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-5010
Mailing Address - Street 1:1919 STATE ST STE 244
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6804
Mailing Address - Country:US
Mailing Address - Phone:812-948-5010
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST STE 244
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6804
Practice Address - Country:US
Practice Address - Phone:812-948-5010
Practice Address - Fax:812-944-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31757207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115900AMedicaid
IN233440AMedicare ID - Type Unspecified
IN145360Medicare PIN
INB28672Medicare UPIN
IN145350Medicare ID - Type Unspecified
IN100115900AMedicaid