Organization
SOUTHERN INDIANA FAMILY PRACTICE CENTER PC
Active
Other names
Southern Indiana Family Practice Center
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN L. REID-RENNER MD (OWNER)
(812) 339-6744
Entity
Organization
Contact information
Practice address
3209 W FULLERTON PIKE, STE A, BLOOMINGTON, IN 47403-4060
(812) 339-6744
(812) 671-9113
Mailing address
3209 W FULLERTON PIKE, STE A, BLOOMINGTON, IN 47403-4060
(812) 339-6744
(812) 671-9113
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
01055670A
IN
363L00000X
Nurse Practitioner
71002130A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200367600A
—
IN
Enumeration date
02/15/2007
Last updated
11/20/2015
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