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401 S Broad St Fremont IN 46737-2114 | |
(260) 667-5685 | |
(260) 495-3621 |
Full Name | |
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Speciality | Clinic/Center |
Location | 401 S Broad St, Fremont, Indiana |
Authorized Official Name and Position | Angela M Logan (CEO) |
Authorized Official Contact | 2606675735 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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416 E Maumee St Angola IN 46703-2015 Ph: (260) 667-5685 | 401 S Broad St Fremont IN 46737-2114 Ph: (260) 667-5685 |
NPI Number | 1043880602 |
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Provider Enumeration Date | 06/28/2021 |
Last Update Date | 02/28/2023 |
Medicare PECOS PAC ID | 9234020835 |
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Medicare Enrollment ID | O20211112001251 |
Identifier | Type | State | Issuer |
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1043880602 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |