| State Of Indiana | |
|
10892 N State Road 140 Knightstown IN 46148-9769 | |
| (765) 345-5141 | |
| (765) 345-7412 |
| Full Name | State Of Indiana |
|---|---|
| Speciality | Clinic/center |
| Location | 10892 N State Road 140, Knightstown, Indiana |
| Authorized Official Name and Position | Allen Collier (ASSISTANT SUPERINTENDENT) |
| Authorized Official Contact | 7653455141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Indiana 10892 N State Road 140 Knightstown IN 46148-9769 Ph: (765) 345-5141 | State Of Indiana 10892 N State Road 140 Knightstown IN 46148-9769 Ph: (765) 345-5141 |
| NPI Number | 1982873717 |
|---|---|
| Provider Enumeration Date | 02/26/2008 |
| Last Update Date | 06/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982873717 | NPI | - | NPPES |
| 200074490 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | STATE OWNED FACILITY (Indiana) | Primary |
Henry County Memorial Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6543 S State Road 109, Knightstown, IN 46148 Phone: 765-521-1516 | |