Provider Demographics
NPI:1699872150
Name:EXPRESSCARE OF SOUTHERN INDIANA
Entity type:Organization
Organization Name:EXPRESSCARE OF SOUTHERN INDIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNCK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:812-542-1901
Mailing Address - Street 1:3897 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9562
Mailing Address - Country:US
Mailing Address - Phone:812-542-1901
Mailing Address - Fax:812-542-1904
Practice Address - Street 1:3897 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9562
Practice Address - Country:US
Practice Address - Phone:812-542-1901
Practice Address - Fax:812-542-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317943OtherANTHEM
IN210410Medicare ID - Type Unspecified