| Fc Indiana, Llc | |
|
2418 16th St Bedford IN 47421-3049 | |
| (931) 253-1110 | |
| (931) 722-9919 |
| Full Name | Fc Indiana, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2418 16th St, Bedford, Indiana |
| Authorized Official Name and Position | Sydni Clemmons (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9013511791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fc Indiana, Llc Po Box 306414 Nashville TN 37230-6414 Ph: (931) 253-1110 | Fc Indiana, Llc 2418 16th St Bedford IN 47421-3049 Ph: (931) 253-1110 |
| NPI Number | 1841911591 |
|---|---|
| Provider Enumeration Date | 09/09/2022 |
| Last Update Date | 09/09/2022 |
| Medicare PECOS PAC ID | 8820360001 |
|---|---|
| Medicare Enrollment ID | O20221005000886 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841911591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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