Organization
PRINCETON CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE G JOHNSON (PRESIDENT/CEO)
(812) 385-8306
Entity
Organization
Contact information
Practice address
121 N HART ST, PRINCETON, IN 47670-1532
(812) 385-5820
(812) 385-5826
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
IN
363A00000X
Physician Assistant
—
IN
Other
Enumeration date
12/13/2012
Last updated
12/13/2012
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