Tri State Internal Medicine Source

NPI 1255646485 - Internal Medicine - 207R00000X

NPI Details
NPI 1255646485
Enumeration Date 08/12/2010
Last Updated 08/12/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name KELLY L KELLY
Position OWNER
Phone (812) 477-4375
Fax (812) 477-3375
Practice Location
3700 BELLEMEADE AVE
STE 119
EVANSVILLE IN, 47714-0102, US
Phone (812) 477-4375
Fax (812) 477-3375
Business Location
3700 BELLEMEADE AVE
STE 119
EVANSVILLE IN, 47714-0102, US
Phone (812) 477-4375
Fax (812) 477-3375
Toxanomy
Taxonomy Code 207R00000X
License State
License Number
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According to our database, Tri State Internal Medicine Source NPI is 1255646485, taxonomy code is 207R00000X Tri State Internal Medicine Source physically located at 3700 Bellemeade Ave, Evansville IN, 47714-0102. NPI Number 1033115704 has the healthcare provider type.

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1255646485 NPI number is provided on an as is basis without warranty of any kind. 1255646485 is maintained by the National Plan & Provider Enumeration System. The contents of Tri State Internal Medicine Source are for informational purposes only.