Provider Demographics
NPI:1053591370
Name:ROHRER FAMILY CLINIC,INC
Entity type:Organization
Organization Name:ROHRER FAMILY CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:812-882-3816
Mailing Address - Street 1:1027 WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2240
Mailing Address - Country:US
Mailing Address - Phone:812-882-3816
Mailing Address - Fax:812-886-5914
Practice Address - Street 1:1027 WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2240
Practice Address - Country:US
Practice Address - Phone:812-882-3816
Practice Address - Fax:812-886-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000342A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM4093Medicare PIN
442630Medicare PIN