Provider Demographics
NPI:1447235619
Name:SOUTHERN INDIANA PATHOLOGISTS
Entity type:Organization
Organization Name:SOUTHERN INDIANA PATHOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-918-3336
Mailing Address - Street 1:PO BOX 3631
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47735-3631
Mailing Address - Country:US
Mailing Address - Phone:314-849-3535
Mailing Address - Fax:
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-918-3336
Practice Address - Fax:812-918-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-10
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200341600AMedicaid
IN185220Medicare PIN