Provider Demographics
NPI:1215062971
Name:SELLERSBURG INTERNAL MEDICINE & PEDIATRICS
Entity type:Organization
Organization Name:SELLERSBURG INTERNAL MEDICINE & PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-248-0800
Mailing Address - Street 1:130 HUNTER STATION WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172
Mailing Address - Country:US
Mailing Address - Phone:812-248-0800
Mailing Address - Fax:812-248-0805
Practice Address - Street 1:130 HUNTER STATION WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172
Practice Address - Country:US
Practice Address - Phone:812-248-0800
Practice Address - Fax:812-248-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INMICHAEL C. HARPERMedicaid
INDAVID C. WHITEMedicaid
INJEANNE M. GREENMedicaid
INDAVID C. WHITEMedicaid
INMICHAEL C. HARPERMedicare UPIN
INJEANNE M. GREENMedicare UPIN
INDAVID C. WHITEMedicare ID - Type Unspecified182650
INMICHAEL C. HARPERMedicaid
INJEANNE M. GREENMedicaid