| Trustees Of Purdue University | |
|
692 E Broadway St Monon IN 47959-8191 | |
| (877) 797-2404 | |
| Not Available |
| Full Name | Trustees Of Purdue University |
|---|---|
| Speciality | Clinic/Center |
| Location | 692 E Broadway St, Monon, Indiana |
| Authorized Official Name and Position | Daniel J Layman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7655643016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trustees Of Purdue University Po Box 597 Delphi IN 46923-0597 Ph: (765) 564-3016 | Trustees Of Purdue University 692 E Broadway St Monon IN 47959-8191 Ph: (877) 797-2404 |
| NPI Number | 1871794826 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 07/12/2024 |
| Certification Date | 07/12/2024 |
| Medicare PECOS PAC ID | 2567373012 |
|---|---|
| Medicare Enrollment ID | O20100208000582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871794826 | NPI | - | NPPES |
| 200852780A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Family Health Clinics Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 304 W Broadway St, Monon, IN 47959 Phone: 765-564-3016 |