| Fortson Family Care And Wellness Center | |
|
1950 45th Ave Suite 100 Munster IN 46321-3917 | |
| (219) 924-9277 | |
| (219) 924-9281 |
| Full Name | Fortson Family Care And Wellness Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1950 45th Ave, Munster, Indiana |
| Authorized Official Name and Position | Darryl L Fortson (PRESIDENT & CEO) |
| Authorized Official Contact | 2199249277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortson Family Care And Wellness Center 1950 45th Ave Suite 100 Munster IN 46321-3917 Ph: (219) 924-9277 | Fortson Family Care And Wellness Center 1950 45th Ave Suite 100 Munster IN 46321-3917 Ph: (219) 924-9277 |
| NPI Number | 1184710428 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 12/03/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184710428 | NPI | - | NPPES |
| 000000359839 | Other | IN | ANTHEM, BC/BS PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01037803 (Indiana) | Primary |
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