Organization Name: | DECATUR COUNTY PRIMARY CARE |
NPI Number: | 1093712887 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARJORIE B. WILLER (CMPLIANCE OFFICER) |
Mailing Address: | 308 Mulberry Street Westport |
State: | IN US |
Postal Code: | 472830620 |
Phone Number: | 8125913452 |
Fax Number: | 8125912999 |
NPI Enumeration Date: | 07/07/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |