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461 Town Center St N Mooresville IN 46158-2316 | |
(317) 584-3255 | |
(317) 584-3259 |
Full Name | |
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Speciality | Family Medicine |
Location | 461 Town Center St N, Mooresville, Indiana |
Authorized Official Name and Position | Jennifer Irene Wakeland Bigelow (OWNER/PRESIDENT) |
Authorized Official Contact | 3175843255 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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461 Town Center St N Mooresville IN 46158-2316 Ph: (317) 584-3255 | 461 Town Center St N Mooresville IN 46158-2316 Ph: (317) 584-3255 |
NPI Number | 1861937419 |
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Provider Enumeration Date | 01/05/2017 |
Last Update Date | 02/23/2017 |
Medicare PECOS PAC ID | 0345647194 |
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Medicare Enrollment ID | O20210922000829 |
Identifier | Type | State | Issuer |
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1861937419 | NPI | - | NPPES |
LPI200198850B | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 01050867A (Indiana) | Primary |
207VX0000X | Obstetrics & Gynecology - Obstetrics | 01050867A (Indiana) | Secondary |
Provider Name | Jennifer W Bigelow |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1750363123 PECOS PAC ID: 8325089485 Enrollment ID: I20050518001144 |
Meridian Health Services Corp. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1001 Hadley Rd Ste 103, Mooresville, IN 46158 Phone: 765-288-1928 | |