Provider Demographics
NPI:1750421129
Name:VINCENNES MEDICAL CORP
Entity type:Organization
Organization Name:VINCENNES MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:REVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-882-0023
Mailing Address - Street 1:700 WILLOW ST
Mailing Address - Street 2:STE 201
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1028
Mailing Address - Country:US
Mailing Address - Phone:812-882-0023
Mailing Address - Fax:812-882-0073
Practice Address - Street 1:700 WILLOW ST
Practice Address - Street 2:STE 201
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1028
Practice Address - Country:US
Practice Address - Phone:812-882-0023
Practice Address - Fax:812-882-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046335A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN185040Medicare ID - Type Unspecified