| |
509 North Street Lafayette IN 47901 | |
(765) 742-8589 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 509 North Street, Lafayette, Indiana |
Authorized Official Name and Position | Joan M Vaughan (DIRECTOR HIPAA PRIVACY COMPLIANCE) |
Authorized Official Contact | 7654961927 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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601 Stadium Mall Dr West Lafayette IN 47907-2052 Ph: (765) 496-1927 | 509 North Street Lafayette IN 47901 Ph: (765) 742-8589 |
NPI Number | 1780885731 |
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Provider Enumeration Date | 05/29/2007 |
Last Update Date | 07/31/2008 |
Identifier | Type | State | Issuer |
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1780885731 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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