Grand Ole Docs of the Southside, LLC

NPI #1477653509 in Greenwood, Indiana

Provider Information

NPI Number: 1477653509
Entity Type: Organization
Organization Name: Grand Ole Docs of the Southside, LLC
Primary Specialty: Family Medicine
Enumeration Date: Sep 25, 2006
Last Updated: Dec 5, 2013

Practice Location

Address: 365 E MAIN ST
City: Greenwood
State: Indiana
ZIP Code: 46143-1361
Phone: (317) 881-5152

Authorized Official

Name: CHARLES R RICHERT, MD
Title: MD
Phone: (317) 881-5152

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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