| Advanced Internal Medicine Llc | |
|
302 N Duke St Peru IN 46970-1520 | |
| (765) 472-3944 | |
| (765) 472-3945 |
| Full Name | Advanced Internal Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 302 N Duke St, Peru, Indiana |
| Authorized Official Name and Position | Gregory A Quin (OWNER) |
| Authorized Official Contact | 7654723944 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Internal Medicine Llc 302 N Duke St P.o. Box 368 Peru IN 46970-1520 Ph: (765) 472-3944 | Advanced Internal Medicine Llc 302 N Duke St Peru IN 46970-1520 Ph: (765) 472-3944 |
| NPI Number | 1124342407 |
|---|---|
| Provider Enumeration Date | 03/16/2010 |
| Last Update Date | 11/19/2013 |
| Medicare PECOS PAC ID | 9436380383 |
|---|---|
| Medicare Enrollment ID | O20140319000105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124342407 | NPI | - | NPPES |
| 200131050 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 01045818 (Indiana) | Primary |
| Provider Name | Gregory Quin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548260714 PECOS PAC ID: 0840181673 Enrollment ID: I20040322001703 |
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