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421 12th Street Logansport IN 46947-3539 | |
(574) 722-7407 | |
(844) 397-1308 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 421 12th Street, Logansport, Indiana |
Authorized Official Name and Position | Tracy J Nagel (CFO) |
Authorized Official Contact | 3175761335 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8003 Castleway Dr Indianapolis IN 46250-1946 Ph: (317) 576-1335 | 421 12th Street Logansport IN 46947-3539 Ph: (574) 722-7407 |
NPI Number | 1154862829 |
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Provider Enumeration Date | 03/15/2017 |
Last Update Date | 03/17/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154862829 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Logansport Family Health Care Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1201 Michigan Avenue, Suite 270, Logansport, IN 46947 Phone: 574-722-4921 Fax: 574-739-0520 | |