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414 Lane St North Judson IN 46366-1226 | |
(574) 896-3444 | |
(574) 896-3435 |
Full Name | |
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Speciality | Family Medicine |
Location | 414 Lane St, North Judson, Indiana |
Authorized Official Name and Position | Rhonda Volk (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2193262485 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1690 La Porte IN 46352-1690 Ph: (219) 326-2312 | 414 Lane St North Judson IN 46366-1226 Ph: (574) 896-3444 |
NPI Number | 1962535799 |
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Provider Enumeration Date | 03/13/2007 |
Last Update Date | 06/06/2008 |
Identifier | Type | State | Issuer |
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1962535799 | NPI | - | NPPES |
100165070X | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |