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Organization

CREEKSIDE OBGYN PC

Active
Parent organization
WITHAM MEMORIAL HOSPITAL
Organization subpart
Yes

Provider details

NPI number
Legal business name
WITHAM MEMORIAL HOSPITAL
Authorized official
SANDRA L ANDERSON (OFFICE MANAGER)
(765) 483-7361
Entity
Organization

Contact information

Practice address
2505 N LEBANON ST, STE 208, LEBANON, IN 46052-8612
(765) 485-8444
(765) 483-7365
Mailing address
2505 N LEBANON ST, STE 208, LEBANON, IN 46052-8612
(765) 485-8444
(765) 483-7365

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
50004241A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200293550
IN
Enumeration date
09/13/2005
Last updated
11/10/2015
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