Organization
RENAISSANCE MEDICAL SPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN PALMER SNOOK M.D. (OWNER)
(812) 524-9222
Entity
Organization
Contact information
Practice address
1414 E TIPTON ST, SEYMOUR, IN 47274-3533
(812) 524-9222
(812) 524-9777
Mailing address
1414 E TIPTON ST, SEYMOUR, IN 47274-3533
(812) 524-9222
(812) 524-9777
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
01047137
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000352813
ANTHEM
IN
01
—
067386
SIHO
IN
Enumeration date
01/31/2007
Last updated
08/22/2020
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