Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 163 Butner Dr, Hope, Indiana |
Authorized Official Name and Position | Michael K Kolenda (CEO) |
Authorized Official Contact | 3177394895 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
14 Trafalgar Sq Trafalgar IN 46181-9515 Ph: (317) 739-4895 | 163 Butner Dr Hope IN 47246-9447 Ph: (812) 546-6000 |
NPI Number | 1346520426 |
---|---|
Provider Enumeration Date | 08/22/2011 |
Last Update Date | 10/09/2019 |
Medicare PECOS PAC ID | 8426965039 |
---|---|
Medicare Enrollment ID | O20060829000554 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346520426 | NPI | - | NPPES |
200127470C | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |