Organization Name: | BROWNSBURG FAMILY MEDICINE CENTER LLC |
NPI Number: | 1295089621 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUDE J MOMODU (CEO) |
Mailing Address: | 480 E Northfield Dr Ste 200 Brownsburg |
State: | IN US |
Postal Code: | 461122434 |
Phone Number: | 3172863171 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2012 |
NPI Last Update Date: | 02/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 01057399A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |