Organization
DR MARK VICKERS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLAM M VICKERS M.D. (PRESIDENT)
(812) 476-6907
Entity
Organization
Contact information
Practice address
2805 LINCOLN AVE, EVANSVILLE, IN 47714-1724
(812) 476-6907
(812) 476-6992
Mailing address
PO BOX 2469, EVANSVILLE, IN 47728-0469
(812) 476-6907
(812) 476-6992
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01043252A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200002730C
—
IN
Enumeration date
11/06/2008
Last updated
04/16/2009
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