Organization
PLAZA PARK FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLEEN M RUBEL NP (PRESIDENT)
(812) 471-4302
Entity
Organization
Contact information
Practice address
3799 VENETIAN WAY, NEWBURGH, IN 47630-8278
(812) 471-4302
(812) 471-4303
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036788A
IN
363L00000X
Nurse Practitioner
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000840875
ANTHEM
IN
05
—
201195100
—
IN
01
—
DU3406
RAILROAD MEDICARE
IN
Enumeration date
09/09/2013
Last updated
02/27/2024
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