Organization
OHIO VALLEY COLON & RECTAL SURGEONS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES D. WALLER JR. M.D. (VICE-PRESIDENT/SECRETARY)
(812) 301-8110
Entity
Organization
Contact information
Practice address
801 ST. MARY'S DRIVE WEST, SUITE 300, EVANSVILLE, IN 47714-0560
(812) 477-9241
(812) 474-6708
Mailing address
801 SAINT MARYS DR, STE 300 W, EVANSVILLE, IN 47714-0511
(812) 477-9241
(812) 474-6708
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
50002315A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000056135
ANTHEM BC/BS
IN
05
—
100246770A
—
IN
05
—
65908493
—
KY
Enumeration date
03/21/2006
Last updated
04/15/2019
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