Organization
SCOTTSBURG FAMILY HEALTHCARE INC
Active
Parent organization
SCOTTSBURG FAMILY HEALTHCARE INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SCOTTSBURG FAMILY HEALTHCARE INC
Authorized official
SHANE ALLEN AVERY MD (CHIEF EXECUTIVE OFFICER)
(812) 752-1151
Entity
Organization
Contact information
Practice address
1465 N. GARDNER ST., SCOTTSBURG, IN 47170-7751
(812) 752-1151
(812) 752-1152
Mailing address
PO BOX 290, SCOTTSBURG, IN 47170-0290
(812) 752-1151
(812) 752-1152
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01045558A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200179420B
—
IN
Enumeration date
10/30/2012
Last updated
04/05/2013
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