Basic Information
| Provider Information | |||||||||
| NPI: | 1760968689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST INDIANA PHYSICIANS ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4447 WYNFALL CT | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450402948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166335988 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 WILSON CREEK RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470252751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125371010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2018 | ||||||||
| LastUpdateDate: | 07/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHIPPA | ||||||||
| AuthorizedOfficialFirstName: | VENU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5166335988 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 010-77-381A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.