| Deja Vu Skin & Health Center | |
|
4943 Rosebud Ln Newburgh IN 47630-9226 | |
| (812) 471-8195 | |
| (812) 490-1060 |
| Full Name | Deja Vu Skin & Health Center |
|---|---|
| Speciality | Family Medicine |
| Location | 4943 Rosebud Ln, Newburgh, Indiana |
| Authorized Official Name and Position | Clovis E. Manley (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8124909462 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deja Vu Skin & Health Center 4943 Rosebud Ln Newburgh IN 47630-9226 Ph: (812) 471-8195 | Deja Vu Skin & Health Center 4943 Rosebud Ln Newburgh IN 47630-9226 Ph: (812) 471-8195 |
| NPI Number | 1972782662 |
|---|---|
| Provider Enumeration Date | 10/30/2007 |
| Last Update Date | 02/19/2024 |
| Medicare PECOS PAC ID | 5799699526 |
|---|---|
| Medicare Enrollment ID | O20031117000428 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972782662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01036788 (Indiana) | Primary |
| 207Q00000X | Family Medicine | 71001387A (Indiana) | Secondary |
| 207Q00000X | Family Medicine | 71001874A (Indiana) | Secondary |
| Provider Name | Clovis E Manley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336212331 PECOS PAC ID: 0749194488 Enrollment ID: I20031125000169 |
| Provider Name | James F Stowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720578404 PECOS PAC ID: 4183975832 Enrollment ID: I20180919004053 |
| Provider Name | Michaela Jean Schuetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699319681 PECOS PAC ID: 3173957685 Enrollment ID: I20191216001753 |
| Provider Name | Natalie Aileen Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679120711 PECOS PAC ID: 1355758681 Enrollment ID: I20210401001190 |
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