Organization
MSO CLINICS, INC.
Active
Parent organization
SULLIVAN COUNTY COMMUNITY HOSPITAL
Other names
Lakeside Family Medical
Organization subpart
Yes
Provider details
NPI number
Legal business name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Authorized official
MRS. MICHELLE FRANKLIN MSN (CEO)
(812) 268-4311
Entity
Organization
Contact information
Practice address
2186 N HOSPITAL BLVD #2, SULLIVAN, IN 47882-7523
(812) 268-3318
(812) 268-4017
Mailing address
PO BOX 230, SULLIVAN, IN 47882-0230
(812) 268-3318
(812) 268-4017
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201246990B
—
IN
01
—
IN2042
MEDICARE PART B
IN
Enumeration date
04/16/2014
Last updated
03/05/2015
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