| Southside Family Practice | |
|
3554 Promenade Pkwy Suite F Lafayette IN 47909-8417 | |
| (765) 471-9146 | |
| (765) 477-0277 |
| Full Name | Southside Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 3554 Promenade Pkwy, Lafayette, Indiana |
| Authorized Official Name and Position | Martha K Miller (DIRECTOR OF BILLING) |
| Authorized Official Contact | 7654465286 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Family Practice Po Box 4699 Lafayette IN 47903-4699 Ph: (765) 449-2732 | Southside Family Practice 3554 Promenade Pkwy Suite F Lafayette IN 47909-8417 Ph: (765) 471-9146 |
| NPI Number | 1346413614 |
|---|---|
| Provider Enumeration Date | 04/08/2008 |
| Last Update Date | 04/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346413614 | NPI | - | NPPES |
| 200107480E | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Indiana) | Primary |
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