| Dale Family Medicine | |
|
4 W Vine St Dale IN 47523 | |
| (812) 937-7140 | |
| (812) 937-7145 |
| Full Name | Dale Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 4 W Vine St, Dale, Indiana |
| Authorized Official Name and Position | Edward Kyle Bennett (PRESIDENT, CEO) |
| Authorized Official Contact | 8129960507 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dale Family Medicine Po Box 1028 Jasper IN 47547-1028 Ph: (812) 996-8478 | Dale Family Medicine 4 W Vine St Dale IN 47523 Ph: (812) 937-7140 |
| NPI Number | 1174603153 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 07/17/2018 |
| Medicare PECOS PAC ID | 4587578042 |
|---|---|
| Medicare Enrollment ID | O20101124000873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174603153 | NPI | - | NPPES |
| CB3118 | Other | KY | RAILROAD MEDICARE |
| 200282080A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
Lifespring, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 South Main St, Dale, IN 47523 Phone: 812-280-2080 |