CLEANSLATE MEDICAL GROUP OF INDIANA LLC (NPI# 1023464294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023464294 |
| Entity Type | Organization |
| Organization Name | CLEANSLATE MEDICAL GROUP OF INDIANA LLC |
| Practice Address |
4411 Washington Ave Ste 105 Evansville IN 47714-0805 |
| Mailing Address |
15 Century Blvd Ste 307 Nashville TN 37214-3692 |
| Practice Telephone | 8122130304 |
| Mailing Telephone | 6154250220 |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2020-11-02 |
| Authorized Official Name | MR. ROBERT HUTCHISON (CFO) |
| Authorized Official Telephone | 6154250220 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
4411 WASHINGTON AVE STE 105 |
| City | EVANSVILLE |
| State | IN |
| Zip Code | 47714-0805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922343490 | Mary Elizabeth Esche | Physical Therapist | 3701 Bellemead Ave, Evansville, IN 47714 | 2012-12-10 |
| 1346524006 | Cheryl Ann Blanford | Pharmacist | 2015 E Covert Ave, Evansville, IN 47714 | 2011-09-29 |
| 1235446014 | Angela Kay Bradford-heidorn | Counselor | 4601 Bayard Park Drive, Evansville, IN 47714 | 2010-09-01 |
| 1104131655 | Cynthia D Lewis | Nurse Practitioner | 3700 Washington Ave Ste 202, Evansville, IN 47714 | 2010-08-09 |
| 1033357363 | Sarah M Voelkel | Podiatrist | 3801 Bellemeade Ave Ste 110a, Evansville, IN 47714 | 2009-01-23 |
| 1346443892 | Shilpa D Gaitonde | Internal Medicine | 3801 Bellemeade Ave Ste 300, Evansville, IN 47714 | 2007-06-11 |
| 1437361516 | Oncology Hematology Associates of Southwest Indiana | Internal Medicine | 3801 Bellemeade Suite 110, Evansville, IN 47714 | 2007-05-03 |
| 1629105374 | Comprehensive Neurosurgical Specialists, LLC | Neurological Surgery | 801 St Mary's Drive, Suite 505 East, Evansville, IN 47714 | 2007-02-28 |
| 1447387949 | Emily Mills | Physical Therapy Assistant | 1800 Elmendorf Avenue, Evanville, IN 47714 | 2007-02-28 |
| 1023153194 | Glen Gilbert Millikan II | Pharmacist | 1550 S. Vann Ave, Evansville, IN 47714 | 2007-02-20 |
| Find all providers in zip 47714 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457551103 | Medical Clinic of Greensburg | Internal Medicine | 203 East North Street, Greesnburg, IN 46240 | 2007-07-20 |
| 1215082813 | Steven E Stoller | Internal Medicine | 1528 Nw 5th St, Suite 100, Richmond, IN 47374-1844 | 2007-01-24 |
| 1265708168 | Shane Jacob Kibbe | Internal Medicine | 1220 Spring St, Jeffersonville, IN 47130-3704 | 2012-03-26 |
| 1104140664 | Adam Scott Lenet | Internal Medicine | 1481 W 10th St, Indianapolis, IN 46202-2803 | 2010-03-26 |
| 1215124474 | William E Washington Jr Md P C | Internal Medicine | 4844 Broadway, Gary, IN 46408-4509 | 2007-10-01 |
| 1053439489 | John Robert Colaluca | Internal Medicine | 898 E Main St, Greenwood, IN 46143-1407 | 2007-03-26 |
| 1740385525 | Rebecca H Kelly | Internal Medicine | 7250 Clearvista Dr, Suite 327a, Indianapolis, IN 46256-4692 | 2006-09-14 |
| 1619072493 | Fairbanks Hospital, Inc. | Internal Medicine | 8102 Clearvista Pkwy, Indianapolis, IN 46256-1661 | 2006-09-14 |
| 1730122268 | Michael Seth Miller | Internal Medicine | 8355 Rockville Rd Ste 120, Indianapolis, IN 46234-2722 | 2006-06-13 |
| City | EVANSVILLE |
| Zip Code | 47714 |
Please comment or provide details below to improve the information on CLEANSLATE MEDICAL GROUP OF INDIANA LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.