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2250 173rd St Hammond IN 46323-2074 | |
| (765) 494-0111 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 2250 173rd St, Hammond, Indiana |
| Authorized Official Name and Position | Jen Hodges (CHIEF CLIENT OFFICER) |
| Authorized Official Contact | 3177279148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1067 Riverfront Pkwy Ste 201 Chattanooga TN 37402-2222 Ph: (423) 902-9530 | 2250 173rd St Hammond IN 46323-2074 Ph: (765) 494-0111 |
| NPI Number | 1407588114 |
|---|---|
| Provider Enumeration Date | 06/30/2022 |
| Last Update Date | 04/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407588114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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