Organization
JACKSON PARK PHYSICIANS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLEY M GILLASPY (PRACTICE MANAGER)
(812) 522-1613
Entity
Organization
Contact information
Practice address
1124 MEDICAL PLACE, SEYMOUR, IN 47274
(812) 522-1613
(812) 522-6694
Mailing address
1124 MEDICAL PLACE, SEYMOUR, IN 47274
(812) 522-1613
(812) 522-6694
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50000714A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100141330
—
IN
Enumeration date
02/01/2007
Last updated
06/25/2013
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