Provider Demographics
NPI:1447376389
Name:RHEUMATOLOGY CENTER OF SOUTHERN INDIANA
Entity type:Organization
Organization Name:RHEUMATOLOGY CENTER OF SOUTHERN INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:WORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-332-1977
Mailing Address - Street 1:637 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2154
Mailing Address - Country:US
Mailing Address - Phone:812-332-1977
Mailing Address - Fax:812-332-1981
Practice Address - Street 1:637 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2154
Practice Address - Country:US
Practice Address - Phone:812-332-1977
Practice Address - Fax:812-332-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty