| Ahi Medical Addictions Clinic, Llc | |
|
3006 Lincolnway E Mishawaka IN 46544-3501 | |
| (574) 252-7233 | |
| (844) 361-2090 |
| Full Name | Ahi Medical Addictions Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3006 Lincolnway E, Mishawaka, Indiana |
| Authorized Official Name and Position | Emma C Wang (OWNER) |
| Authorized Official Contact | 5742527233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ahi Medical Addictions Clinic, Llc 3006 Lincolnway E Mishawaka IN 46544-3501 Ph: (574) 252-7233 | Ahi Medical Addictions Clinic, Llc 3006 Lincolnway E Mishawaka IN 46544-3501 Ph: (574) 252-7233 |
| NPI Number | 1457896896 |
|---|---|
| Provider Enumeration Date | 12/20/2016 |
| Last Update Date | 09/01/2020 |
| Certification Date | 08/31/2020 |
| Medicare PECOS PAC ID | 8325466048 |
|---|---|
| Medicare Enrollment ID | O20200914000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457896896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 207QA0401X | Family Medicine - Addiction Medicine | BX2361145 (Indiana) | Primary |
| Provider Name | Emma C Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982647434 PECOS PAC ID: 5890719652 Enrollment ID: I20060119000276 |
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