Provider Demographics
NPI:1043356520
Name:SOUTHERN INDIANA PHYSICIANS FOR WOMEN
Entity type:Organization
Organization Name:SOUTHERN INDIANA PHYSICIANS FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-334-3955
Mailing Address - Street 1:1010 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2217
Mailing Address - Country:US
Mailing Address - Phone:812-334-3955
Mailing Address - Fax:812-334-5792
Practice Address - Street 1:1010 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2217
Practice Address - Country:US
Practice Address - Phone:812-334-3955
Practice Address - Fax:812-334-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200350420AMedicaid
IN200350420AMedicaid