Community Care Network | |
9660 Wicker Ave St John IN 46373-9487 | |
(219) 365-1166 | |
(219) 365-8852 |
Full Name | Community Care Network |
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Speciality | Family Medicine |
Location | 9660 Wicker Ave, St John, Indiana |
Authorized Official Name and Position | Donald P Fesko (CEO) |
Authorized Official Contact | 2198361600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Community Care Network 9660 Wicker Ave St John IN 46373-9487 Ph: (219) 365-1166 | Community Care Network 9660 Wicker Ave St John IN 46373-9487 Ph: (219) 365-1166 |
NPI Number | 1922008689 |
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Provider Enumeration Date | 07/26/2005 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922008689 | NPI | - | NPPES |
200289040 | Medicaid | IN | |
90000970 | Other | IL | BCBS OF ILLINOIS |
CH9533 | Other | IN | MEDICARE RAILROAD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Indiana) | Primary |
207Q00000X | Family Medicine | (Indiana) | Secondary |
208000000X | Pediatrics | (Indiana) | Secondary |