| Healthlinc - Mishawaka | |
|
420 W 4th St Mishawaka IN 46544 | |
| (574) 307-7673 | |
| (574) 307-7692 |
| Full Name | Healthlinc - Mishawaka |
|---|---|
| Speciality | Clinic/Center |
| Location | 420 W 4th St, Mishawaka, Indiana |
| Authorized Official Name and Position | Melissa Mitchell (CEO) |
| Authorized Official Contact | 2194659503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthlinc - Mishawaka 2401 Valley Dr Valparaiso IN 46383-2520 Ph: (219) 413-5100 | Healthlinc - Mishawaka 420 W 4th St Mishawaka IN 46544 Ph: (574) 307-7673 |
| NPI Number | 1417244989 |
|---|---|
| Provider Enumeration Date | 07/06/2011 |
| Last Update Date | 01/12/2024 |
| Medicare PECOS PAC ID | 7618929373 |
|---|---|
| Medicare Enrollment ID | O20110809000646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417244989 | NPI | - | NPPES |
| 200317310E | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | H80CS06662 (Indiana) | Primary |
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