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10327 Dawsons Creek Blvd 9 D Wayne IN 46825 | |
(260) 424-8770 | |
(260) 469-8774 |
Full Name | |
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Speciality | Family Medicine |
Location | 10327 Dawsons Creek Blvd 9 D, Wayne, Indiana |
Authorized Official Name and Position | Walter David Pepple (PRESIDENT) |
Authorized Official Contact | 2604228770 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10327 Dawsons Creek Blvd 9 D Wayne IN 46825 Ph: (260) 424-8770 | 10327 Dawsons Creek Blvd 9 D Wayne IN 46825 Ph: (260) 424-8770 |
NPI Number | 1154382729 |
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Provider Enumeration Date | 03/31/2006 |
Last Update Date | 07/15/2014 |
Medicare PECOS PAC ID | 7416073952 |
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Medicare Enrollment ID | O20100922000312 |
Identifier | Type | State | Issuer |
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1154382729 | NPI | - | NPPES |
100103630D | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 01023389 (Indiana) | Primary |
Provider Name | Walter David Pepple |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1578637831 PECOS PAC ID: 8325164866 Enrollment ID: I20100922000337 |