Provider Demographics
NPI:1801071402
Name:ORACLE PRIME,LLC
Entity type:Organization
Organization Name:ORACLE PRIME,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-280-0160
Mailing Address - Street 1:201 E MARKET ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3362
Mailing Address - Country:US
Mailing Address - Phone:812-280-0160
Mailing Address - Fax:812-280-0160
Practice Address - Street 1:201 E MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3362
Practice Address - Country:US
Practice Address - Phone:812-280-0160
Practice Address - Fax:812-280-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000624A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty