Provider Demographics
NPI:1336731330
Name:DIRECT PATIENT CARE OF EVANSVILLE, LLC
Entity Type:Organization
Organization Name:DIRECT PATIENT CARE OF EVANSVILLE, LLC
Other - Org Name:DIRECT PATIENT CARE OF EVANSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JENISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-297-6310
Mailing Address - Street 1:1202 W BUENA VISTA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5185
Mailing Address - Country:US
Mailing Address - Phone:812-297-6310
Mailing Address - Fax:812-437-8243
Practice Address - Street 1:1202 W BUENA VISTA RD STE 102
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5185
Practice Address - Country:US
Practice Address - Phone:812-297-6310
Practice Address - Fax:812-437-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center