| Indian Lake Community Health Center | |
|
8200 State Route 366 Suite No. 1 Russells Point OH 43348-9670 | |
| (937) 599-1411 | |
| (937) 599-4128 |
| Full Name | Indian Lake Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 8200 State Route 366, Russells Point, Ohio |
| Authorized Official Name and Position | Tara D Bair (PRESIDENT/CEO) |
| Authorized Official Contact | 9378871013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Lake Community Health Center 4879 St. Rt. 68 South West Liberty OH 43357 Ph: (937) 599-1411 | Indian Lake Community Health Center 8200 State Route 366 Suite No. 1 Russells Point OH 43348-9670 Ph: (937) 599-1411 |
| NPI Number | 1962828293 |
|---|---|
| Provider Enumeration Date | 03/11/2014 |
| Last Update Date | 12/12/2016 |
| Medicare PECOS PAC ID | 8022247469 |
|---|---|
| Medicare Enrollment ID | O20140519002338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962828293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Costin Family Practice, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 303 East Main Street, Russells Point, OH 43348 Phone: 937-843-2453 | |
Community Health & Wellness Partners Of Logan County Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8200 State Route 366 Ste 1, Russells Point, OH 43348 Phone: 937-599-1411 Fax: 937-599-4128 | |
Indian Lake Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 322 E Main St, Russells Point, OH 43348 Phone: 937-842-2318 Fax: 937-842-2414 | |
Lakeview Medical, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8200 State Route 366, Russells Point, OH 43348 Phone: 937-843-5000 Fax: 937-843-2801 | |
Mary Rutan Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8200 State Route 366 Ste 8, Russells Point, OH 43348 Phone: 937-292-5063 Fax: 937-292-5073 |