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3601 Sagamore Pkwy N Lafayette IN 47904-5041 | |
| (765) 586-4764 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3601 Sagamore Pkwy N, Lafayette, Indiana |
| Authorized Official Name and Position | Jennifer Sue Wood (CEO) |
| Authorized Official Contact | 7655864764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7611 S 350 E Lafayette IN 47909-8112 Ph: (765) 586-4764 | 3601 Sagamore Pkwy N Lafayette IN 47904-5041 Ph: (765) 586-4764 |
| NPI Number | 1023859436 |
|---|---|
| Provider Enumeration Date | 06/03/2024 |
| Last Update Date | 07/13/2024 |
| Certification Date | 07/13/2024 |
| Medicare PECOS PAC ID | 8123561354 |
|---|---|
| Medicare Enrollment ID | O20240617001705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023859436 | NPI | - | NPPES |
| Provider Name | Jennifer Sue Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255039244 PECOS PAC ID: 4082069455 Enrollment ID: I20231005001397 |
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