| |
420 W Longest St Paoli IN 47454-8821 | |
(812) 723-3944 | |
(812) 723-5292 |
Full Name | |
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Speciality | Clinic/Center |
Location | 420 W Longest St, Paoli, Indiana |
Authorized Official Name and Position | Nancy Radcliff (CEO) |
Authorized Official Contact | 8127237118 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 270 Paoli IN 47454-0270 Ph: (812) 723-7118 | 420 W Longest St Paoli IN 47454-8821 Ph: (812) 723-3944 |
NPI Number | 1386151371 |
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Provider Enumeration Date | 12/29/2017 |
Last Update Date | 02/03/2023 |
Medicare PECOS PAC ID | 5799694360 |
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Medicare Enrollment ID | O20180309002045 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386151371 | NPI | - | NPPES |
200937580A | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Indiana) | Primary |