Provider Demographics
NPI:1982117172
Name:ANDRY MEDICAL SERVICES
Entity Type:Organization
Organization Name:ANDRY MEDICAL SERVICES
Other - Org Name:ANDRY HEALTH & WELLENSS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-331-8282
Mailing Address - Street 1:451 S PARK RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8589
Mailing Address - Country:US
Mailing Address - Phone:812-331-8282
Mailing Address - Fax:
Practice Address - Street 1:451 S PARK RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8589
Practice Address - Country:US
Practice Address - Phone:812-331-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty