Perry County Family Practice | |
18485 State Rd 37 Leopold IN 47551-8072 | |
(812) 843-3038 | |
(812) 843-3084 |
Full Name | Perry County Family Practice |
---|---|
Speciality | Clinic/Center |
Location | 18485 State Rd 37, Leopold, Indiana |
Authorized Official Name and Position | Brian Herwig (CEO) |
Authorized Official Contact | 8125470170 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Perry County Family Practice 8885 State Road 237 Tell City IN 47586-8567 Ph: (812) 547-7011 | Perry County Family Practice 18485 State Rd 37 Leopold IN 47551-8072 Ph: (812) 843-3038 |
NPI Number | 1215928536 |
---|---|
Provider Enumeration Date | 11/04/2005 |
Last Update Date | 11/16/2022 |
Medicare PECOS PAC ID | 6204867559 |
---|---|
Medicare Enrollment ID | O20050825000962 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215928536 | NPI | - | NPPES |
65944290 | Medicaid | KY | |
15D1043196 | Other | IN | CLIA |
000000371434 | Other | IN | ANTHEM |
200531240A | Medicaid | IN | |
78904927 | Medicaid | KY |
Provider Name | Andrea Marie Polk |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427368208 PECOS PAC ID: 4284821901 Enrollment ID: I20101207001205 |
Provider Name | Jerry K Pearson |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1043252166 PECOS PAC ID: 8921036740 Enrollment ID: I20140520000812 |
Provider Name | Samantha Polk |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417357542 PECOS PAC ID: 8426370388 Enrollment ID: I20141203001258 |
Provider Name | Beth Sharp |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457893844 PECOS PAC ID: 3870876022 Enrollment ID: I20170213002419 |
Provider Name | Shawn Sikka |
---|---|
Provider Type | Practitioner - Pain Management |
Provider Identifiers | NPI Number: 1366797201 PECOS PAC ID: 4385918788 Enrollment ID: I20180612000059 |
Provider Name | Krystle Susan Hahus |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1275974255 PECOS PAC ID: 7911149471 Enrollment ID: I20180920002013 |