Provider Demographics
NPI:1699769349
Name:NEUROSURGERY OF SOUTHERN INDIANA, LLC
Entity type:Organization
Organization Name:NEUROSURGERY OF SOUTHERN INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-373-9730
Mailing Address - Street 1:2326 18TH ST
Mailing Address - Street 2:STE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5359
Mailing Address - Country:US
Mailing Address - Phone:812-373-9730
Mailing Address - Fax:812-373-9734
Practice Address - Street 1:2326 18TH ST
Practice Address - Street 2:STE 120
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5359
Practice Address - Country:US
Practice Address - Phone:812-373-9730
Practice Address - Fax:812-373-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty