Scottsburg Family Healthcare Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01045558A Issued in IN

Legal business name

SCOTTSBURG FAMILY HEALTHCARE INC

Practice address

1465 N. Gardner St.
Scottsburg, IN 47170-7751

Phone

(812) 752-1151

Fax

(812) 752-1152

NPI assigned

Oct 30, 2012

Organization subpart

Yes

Parent organization

SCOTTSBURG FAMILY HEALTHCARE INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shane Allen Avery, MD

Title

Chief Executive Officer

Phone

(812) 752-1151

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Scottsburg Family HLTH Inc

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365120000000",
    "number": "1124372131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290",
            "city": "SCOTTSBURG",
            "state": "IN",
            "postal_code": "471700290",
            "telephone_number": "812-752-1151",
            "fax_number": "812-752-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 N. GARDNER ST.",
            "city": "SCOTTSBURG",
            "state": "IN",
            "postal_code": "471707751",
            "telephone_number": "812-752-1151",
            "fax_number": "812-752-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTSBURG FAMILY HEALTHCARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCOTTSBURG FAMILY HEALTHCARE INC",
        "enumeration_date": "2012-10-30",
        "last_updated": "2013-04-05",
        "status": "A",
        "authorized_official_last_name": "AVERY",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "812-752-1151",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01045558A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200179420B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Memorial Hospital
• Scott Physician Group LLC
• Scott Villa Care, LLC
• Scottsburg Emergency Services, LLC
• Scottsburg Family Dentistry LLC
• Scottsburg Radiology Associates PSC
• Katherine Virginia Shannon, M.D.
• Brooke Jessamine Sherman, OTR
• Kate L Short, NP
• Shree Swaminarayan LLC

• Family Medicine Physician in Scottsburg, IN
• Providers in Scottsburg, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.