| Primary Care At Mishawaka | |
|
410 Park Pl Ste A Mishawaka IN 46545-3557 | |
| (574) 252-0667 | |
| (574) 807-8845 |
| Full Name | Primary Care At Mishawaka |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 410 Park Pl Ste A, Mishawaka, Indiana |
| Authorized Official Name and Position | Kevin R Boyer (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5742963200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care At Mishawaka 410 Park Pl Suite A Mishawaka IN 46545-3557 Ph: (574) 252-0667 | Primary Care At Mishawaka 410 Park Pl Ste A Mishawaka IN 46545-3557 Ph: (574) 252-0667 |
| NPI Number | 1851497945 |
|---|---|
| Provider Enumeration Date | 09/15/2006 |
| Last Update Date | 05/08/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851497945 | NPI | - | NPPES |
| 100466600 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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