| Leestma Medical Clinic, Inc | |
|
519 N Halleck St Demotte IN 46310-9553 | |
| (219) 987-7750 | |
| (219) 987-5750 |
| Full Name | Leestma Medical Clinic, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 519 N Halleck St, Demotte, Indiana |
| Authorized Official Name and Position | Eric J Leestma (PRESIDENT) |
| Authorized Official Contact | 2199877750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leestma Medical Clinic, Inc Po Box 850 Demotte IN 46310-0850 Ph: (219) 987-7750 | Leestma Medical Clinic, Inc 519 N Halleck St Demotte IN 46310-9553 Ph: (219) 987-7750 |
| NPI Number | 1487986451 |
|---|---|
| Provider Enumeration Date | 02/02/2010 |
| Last Update Date | 05/04/2010 |
| Medicare PECOS PAC ID | 1850290263 |
|---|---|
| Medicare Enrollment ID | O20040105000827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487986451 | NPI | - | NPPES |
| 080088241 | Other | RAILROAD MEDICARE | |
| 100209310A | Medicaid | IN | |
| 000000084931 | Other | IN | ANTHEM BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 02000641A (Indiana) | Primary |
| Provider Name | Sharon A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104951409 PECOS PAC ID: 9335048743 Enrollment ID: I20040105000850 |
| Provider Name | Eric J Leestma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700989233 PECOS PAC ID: 8820997232 Enrollment ID: I20100312000666 |
| Provider Name | Micah J Leestma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013201623 PECOS PAC ID: 9133342462 Enrollment ID: I20140805001419 |
| Provider Name | Adam Jon Leestma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891230140 PECOS PAC ID: 0840575213 Enrollment ID: I20170327001651 |
Northshore Health Centers, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 200 3rd Ct Se, Demotte, IN 46310 Phone: 219-763-8112 | |
Connection Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1317 15th St. Se, Demotte, IN 46310 Phone: 219-987-4280 | |
Demotte Physicians Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 8th Ave Ne, Demotte, IN 46310 Phone: 219-987-3581 Fax: 219-987-7137 | |
Surya K Nallari Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 10th St Sw, Demotte, IN 46310 Phone: 219-987-6010 | |
Northshore Health Centers, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 3rd Ct Se, Demotte, IN 46310 Phone: 219-763-8112 Fax: 219-764-5333 |