Southern Indiana Family Practice Center
LBN: Southern Indiana Family Practice Center Pc
Southern Indiana Family Practice Center is an health care organization with primary practice located at 3209 W Fullerton Pike Ste A, Bloomington IN 47403-4060. The organization recently has 2 registered licenses in different health care specialties including Managed Care Organizations / Preferred Provider Organization, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Managed Care Organizations / Preferred Provider Organization is the primary health care specialty.
Southern Indiana Family Practice Center Pc can be contacted via phone (812) 339-6744, or through Reid-Renner, Karen L. via phone (812) 339-6744.
Contact Information
Primary practice address
3209 W Fullerton Pike Ste A
Bloomington IN 47403-4060
Phone: (812) 339-6744
Fax: (812) 671-9113
Website:
Authorized official contact:
Name: Reid-Renner, Karen L. Doctor of Medicine (MD)
Phone: (812) 339-6744
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Managed Care Organizations / Preferred Provider Organization | 305R00000X | 01055670A | Indiana |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 71002130A | Indiana |
Profile Details
| NPI number | 1770626152 |
|---|---|
| LBN Legal business name | Southern Indiana Family Practice Center Pc |
| DBA Doing business as | Southern Indiana Family Practice Center |
| Authorized official | Reid-Renner, Karen L. Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 15th, 2007 |
| Last updated | Nov 20th, 2015 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770626152 | NPPES |
| Indiana | MEDICAID | 200367600A |
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