Provider Demographics
NPI:1548707425
Name:EVANSVILLE ADVANCED TREATMENT CENTER
Entity type:Organization
Organization Name:EVANSVILLE ADVANCED TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-303-9539
Mailing Address - Street 1:4972 LINCOLN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7909
Mailing Address - Country:US
Mailing Address - Phone:812-303-9539
Mailing Address - Fax:812-402-4611
Practice Address - Street 1:4972 LINCOLN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7909
Practice Address - Country:US
Practice Address - Phone:812-402-4645
Practice Address - Fax:812-402-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061287A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty