Basic Information
| Provider Information | |||||||||
| NPI: | 1720380959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SICC SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3276 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477313276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124911328 | ||||||||
| FaxNumber: | 8124926328 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 W COLUMBIA ST # AT | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477101782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124911328 | ||||||||
| FaxNumber: | 8124926328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2010 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | ARMEANU | ||||||||
| AuthorizedOfficialFirstName: | EMILIAN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8124911328 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 01063229A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.