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2701b Kent Ave W Lafayette IN 47906-1350 | |
(812) 308-8400 | |
(765) 600-9796 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 2701b Kent Ave, W Lafayette, Indiana |
Authorized Official Name and Position | Mark Kemble (VP OF MEDICAL AFFAIRS) |
Authorized Official Contact | 8645010815 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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10 Centimeters Dr Mauldin SC 29662-3278 Ph: (864) 501-0751 | 2701b Kent Ave W Lafayette IN 47906-1350 Ph: (812) 308-8400 |
NPI Number | 1952924896 |
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Provider Enumeration Date | 05/27/2020 |
Last Update Date | 09/28/2020 |
Identifier | Type | State | Issuer |
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1952924896 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |