Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 202 N West St, Odon, Indiana |
Authorized Official Name and Position | Ken Parsons (PRESIDENT OF BOARD OF DIRECTORS) |
Authorized Official Contact | 8122548620 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
202 N West St Odon IN 47562-1032 Ph: (812) 636-7300 | 202 N West St Odon IN 47562-1032 Ph: (812) 636-7300 |
NPI Number | 1942368469 |
---|---|
Provider Enumeration Date | 12/05/2006 |
Last Update Date | 01/02/2021 |
Medicare PECOS PAC ID | 1557271665 |
---|---|
Medicare Enrollment ID | O20030620000025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942368469 | NPI | - | NPPES |
200152680A | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 01043657A (Indiana) | Primary |