Provider Demographics
NPI:1124072137
Name:RISING SUN MEDICAL CENTER INC
Entity type:Organization
Organization Name:RISING SUN MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-537-8200
Mailing Address - Street 1:PO BOX 639352
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9352
Mailing Address - Country:US
Mailing Address - Phone:812-537-8241
Mailing Address - Fax:812-537-1041
Practice Address - Street 1:230 6TH ST
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-1114
Practice Address - Country:US
Practice Address - Phone:812-438-2555
Practice Address - Fax:812-438-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1619948015OtherINDIVIDUAL NPI
IN1841262011OtherINDIVIDUAL NPI
IN000000037297OtherANTHEM
IN200203240AMedicaid
IN1841262011OtherINDIVIDUAL NPI