| Lifeline Medical Center | |
|
2101 Jackson St Ste 109 Anderson IN 46016-4386 | |
| (814) 408-0014 | |
| Not Available |
| Full Name | Lifeline Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 2101 Jackson St Ste 109, Anderson, Indiana |
| Authorized Official Name and Position | Patricia Griesheimer (COO) |
| Authorized Official Contact | 8142430414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeline Medical Center 3159 Carpenters Park Rd Davidsville PA 15928-9223 Ph: (814) 408-0014 | Lifeline Medical Center 2101 Jackson St Ste 109 Anderson IN 46016-4386 Ph: (814) 408-0014 |
| NPI Number | 1265160451 |
|---|---|
| Provider Enumeration Date | 08/15/2022 |
| Last Update Date | 11/06/2024 |
| Certification Date | 11/06/2024 |
| Medicare PECOS PAC ID | 3678948577 |
|---|---|
| Medicare Enrollment ID | O20230427002507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265160451 | NPI | - | NPPES |
| 99999999999 | Medicaid | OR |
| Provider Name | Terry Alicia Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215025481 PECOS PAC ID: 0547418857 Enrollment ID: I20190604002152 |
| Provider Name | Temitayo M Olagbemi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124545645 PECOS PAC ID: 4082040290 Enrollment ID: I20200220001980 |
| Provider Name | Deangella R Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700328135 PECOS PAC ID: 2365724838 Enrollment ID: I20220425001398 |
| Provider Name | Marilyn J Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407041775 PECOS PAC ID: 4789049073 Enrollment ID: I20230517003194 |
| Provider Name | Long Hoang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861694424 PECOS PAC ID: 8820122393 Enrollment ID: I20230517003323 |
| Provider Name | Tihana Sladic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184231805 PECOS PAC ID: 6002226214 Enrollment ID: I20230601001363 |
| Provider Name | Munachiso Iheonunekwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922505908 PECOS PAC ID: 3274882352 Enrollment ID: I20230908002492 |
| Provider Name | Jessica Bentura-jimenez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285392126 PECOS PAC ID: 4082068002 Enrollment ID: I20230926000066 |
| Provider Name | Lakeetra Catchings |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558664219 PECOS PAC ID: 2163874009 Enrollment ID: I20240117000568 |
| Provider Name | Tameka Gibson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265782767 PECOS PAC ID: 7517317662 Enrollment ID: I20240123004338 |
| Provider Name | Jessica Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649954405 PECOS PAC ID: 4284070061 Enrollment ID: I20240314004302 |
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