Southern Indiana Community Health Care, Inc
Organization Active NPI Family Medicine Physician · Marengo, IN
NPI 1700909348 · NPPES record last updated Aug 31, 2020
Key facts
- NPI
- 1700909348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
- Practice address
- 5604 E White Oak LN
Marengo, IN 47140-8413 - Phone
- (812) 365-3221
- Fax
- (812) 365-9502
- NPI assigned
- Apr 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Tonya M Jones, CPB
- Title
- Billing Manager
- Phone
- (812) 723-7119
Other NPIs on the same Medicare enrollment 8
Practitioners 2
-
Elisabeth Ann Throop, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040525000541 | IN | Part B Supplier - Clinic/Group Practice | 5799694360 |
Receives reassigned benefits from 37 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Orleans, IN; Paoli, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
5604 E White Oak LN
Marengo, IN 47140-8413
Mailing address
420 W Longest St
PO Box 270
Paoli, IN 47454-8821
Phone (812) 723-7119
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200122740A | Medicaid | IN | |
| CI7706 | Other | IN | MEDICARE ID |
Other names
- Crawford County Family Health Care
Other providers in Marengo, IN
- Engleking RX Marengo LLC
- Jefferson Street Holdings LLC
- Deborah J. Reichenbach
- Christi Lee Self
- Jennifer Dawn Shafer
- Southern Indiana Community Health Care, Inc
- Susan Stein
- Joni Stroudmartin
- Curtis Carlyle Thill
- Elisabeth Ann Throop
All providers in Marengo, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.