| Bristol Street Family Practice | |
|
609 W Bristol St Elkhart IN 46514-2900 | |
| (574) 262-2817 | |
| (574) 262-2941 |
| Full Name | Bristol Street Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 609 W Bristol St, Elkhart, Indiana |
| Authorized Official Name and Position | Richard Allen Hastings (OWNER) |
| Authorized Official Contact | 5742622817 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bristol Street Family Practice 609 W Bristol St Elkhart IN 46514-2900 Ph: (574) 262-2817 | Bristol Street Family Practice 609 W Bristol St Elkhart IN 46514-2900 Ph: (574) 262-2817 |
| NPI Number | 1467510966 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467510966 | NPI | - | NPPES |
| 100112380A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01027071A (Indiana) | Primary |
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