Gosport Family Practice | |
7 E Main St Gosport IN 47433-7034 | |
(812) 879-4222 | |
(812) 879-4834 |
Full Name | Gosport Family Practice |
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Speciality | Clinic/center - Rural Health |
Location | 7 E Main St, Gosport, Indiana |
Authorized Official Name and Position | Marlon B Fishel (ADMINISTRATION, IU HEALTH SIP) |
Authorized Official Contact | 8123535866 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Gosport Family Practice Po Box 1329 Bloomington IN 47402-1329 Ph: (812) 879-4222 | Gosport Family Practice 7 E Main St Gosport IN 47433-7034 Ph: (812) 879-4222 |
NPI Number | 1003074972 |
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Provider Enumeration Date | 05/28/2008 |
Last Update Date | 07/27/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003074972 | NPI | - | NPPES |
200874400A | Medicaid | IN | |
CI4187 | Other | IN | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Indiana) | Primary |