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200 S Jfk Ave Loogootee IN 47553-1624 | |
(812) 295-3090 | |
(812) 295-4328 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 200 S Jfk Ave, Loogootee, Indiana |
Authorized Official Name and Position | John Manning (VP BEHAVIORAL HEALTH/SPEC PROJECTS) |
Authorized Official Contact | 8128866800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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515 Bayou St Vincennes IN 47591-1034 Ph: (812) 886-6800 | 200 S Jfk Ave Loogootee IN 47553-1624 Ph: (812) 295-3090 |
NPI Number | 1679571228 |
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Provider Enumeration Date | 07/08/2005 |
Last Update Date | 04/24/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679571228 | NPI | - | NPPES |
301936 | Other | IN | VALUE OPTIONS FACILITY |
192467000 | Other | IN | MAGELLAN |
000000574037 | Other | IN | ANTHEM PIN FOR THIS LOCATION |
165526 | Other | IN | MHN GROUP |
100270140G | Medicaid | IN | |
100270140B | Medicaid | IN |