Provider Demographics
NPI:1881880938
Name:VINCENNES PODIATRY ASSOCIATES, LLC
Entity type:Organization
Organization Name:VINCENNES PODIATRY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BESING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-882-3312
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-0943
Mailing Address - Country:US
Mailing Address - Phone:812-882-3312
Mailing Address - Fax:812-882-6181
Practice Address - Street 1:202 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1228
Practice Address - Country:US
Practice Address - Phone:812-882-3312
Practice Address - Fax:812-882-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000905213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN254060OtherMEDICARE
IN6158520001Medicare NSC