Organization
COLEMAN INSTITUTE- INDIANA PETER RICHARD COLEMAN SOLE MBR
Active
Other names
Jeffersonville Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN F SHIELDS (BILLING MANAGER)
(804) 282-9133
Entity
Organization
Contact information
Practice address
1035 WALL ST, SUITE 204, JEFFERSONVILLE, IN 47130-3612
(812) 288-8410
(812) 288-8409
Mailing address
1035 WALL ST, SUITE 204, JEFFERSONVILLE, IN 47130-3612
(812) 288-8410
(812) 288-8409
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001067A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437214731
—
IN
Enumeration date
06/17/2010
Last updated
10/07/2010
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