NPIMap

Organization Active NPI

Southern Indiana Pediatrics P.S.C.

  • Pediatrics Physician
  • Jeffersonville, IN
National Provider Identifier
1811043854
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
50002306A Issued in IN
Legal business name
SOUTHERN INDIANA PEDIATRICS P.S.C.
Practice address
1701 Spring St
Suite a.
Jeffersonville, IN 47130-2930
Phone
(812) 282-1367
Fax
(812) 284-8377
NPI assigned
Jan 25, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Lynn R Gulley, M.D.NPI 1386756872
Title
President
Phone
(812) 282-1367

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 50002306A IN Primary

Addresses

Primary practice location

1701 Spring St
Suite a.
Jeffersonville, IN 47130-2930

Mailing address

1701 Spring St
Suite a.
Jeffersonville, IN 47130-2930
Phone (812) 282-1367

National Provider Directory

National Provider Directory

Locations

1701 Spring St
Ste A
Jeffersonville, IN 47130
Phone (812) 282-1367

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811043854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SPRING ST",
            "address_2": "SUITE A.",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471302930",
            "telephone_number": "812-282-1367",
            "fax_number": "812-284-8377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SPRING ST",
            "address_2": "SUITE A.",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471302930",
            "telephone_number": "812-282-1367",
            "fax_number": "812-284-8377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIANA PEDIATRICS P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GULLEY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-282-1367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "50002306A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.