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560 W. Longest Street Paoli IN 47454-9670 | |
(812) 723-7440 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 560 W. Longest Street, Paoli, Indiana |
Authorized Official Name and Position | Michael L Craig (CFO) |
Authorized Official Contact | 8123539171 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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250 N Shadeland Ave Indianapolis IN 46219-4959 Ph: () - | 560 W. Longest Street Paoli IN 47454-9670 Ph: (812) 723-7440 |
NPI Number | 1679182190 |
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Provider Enumeration Date | 07/30/2020 |
Last Update Date | 07/31/2020 |
Medicare PECOS PAC ID | 2668426016 |
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Medicare Enrollment ID | O20200813000878 |
Identifier | Type | State | Issuer |
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1679182190 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |