Organization
SOUTHERN INDIANA SURGERY CENTER, LLC
Active
Other names
Southern Indiana Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MISTY SCALES (BUSINESS OFFICE MANAGER)
(812) 333-8969
Entity
Organization
Contact information
Practice address
2800 REX GROSSMAN BLVD, BLOOMINGTON, IN 47403-5145
(812) 333-8969
(812) 335-2309
Mailing address
2800 REX GROSSMAN BLVD, BLOOMINGTON, IN 47403-5145
(812) 333-8969
(812) 335-2309
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
06-006102-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100274500A
—
IN
Enumeration date
10/19/2006
Last updated
03/15/2010
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