| Booth Medical Center Pc | |
|
2600 N Detroit St Lagrange IN 46761-1154 | |
| (260) 463-4896 | |
| (260) 463-5242 |
| Full Name | Booth Medical Center Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2600 N Detroit St, Lagrange, Indiana |
| Authorized Official Name and Position | Lisa N Booth (PHYSICIAN OWNER) |
| Authorized Official Contact | 2604634896 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Booth Medical Center Pc 2600 N Detroit St Lagrange IN 46761-1154 Ph: (260) 463-4896 | Booth Medical Center Pc 2600 N Detroit St Lagrange IN 46761-1154 Ph: (260) 463-4896 |
| NPI Number | 1659448975 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 07/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659448975 | NPI | - | NPPES |
| 100468460 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01041550A (Indiana) | Primary |
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