Basic Information
| Provider Information | |||||||||
| NPI: | 1437359775 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN INDIANA OBGYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 939 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH VERNON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472652602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123486373 | ||||||||
| FaxNumber: | 8123764125 | ||||||||
| Practice Location | |||||||||
| Address1: | 939 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH VERNON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472652602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123486373 | ||||||||
| FaxNumber: | 8123764125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | WINGHAM | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8123486373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.