| Holtsclaw Medical Centre, Llc | |
|
4666 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6892 | |
| (260) 432-0100 | |
| Not Available |
| Full Name | Holtsclaw Medical Centre, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4666 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Lisa Michelle Holtsclaw (MEMBER) |
| Authorized Official Contact | 2604320100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Holtsclaw Medical Centre, Llc 4666 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6892 Ph: (260) 432-0100 | Holtsclaw Medical Centre, Llc 4666 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6892 Ph: (260) 432-0100 |
| NPI Number | 1235146812 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235146812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 02001568A (Indiana) | Primary |
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