| Christian Clinic Pc | |
|
716 S College Ave Rensselaer IN 47978-3083 | |
| (219) 866-0485 | |
| (219) 866-0837 |
| Full Name | Christian Clinic Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 716 S College Ave, Rensselaer, Indiana |
| Authorized Official Name and Position | James G Wakefield (OWNER) |
| Authorized Official Contact | 2198660485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christian Clinic Pc 716 S College Ave Rensselaer IN 47978-3083 Ph: (219) 866-0485 | Christian Clinic Pc 716 S College Ave Rensselaer IN 47978-3083 Ph: (219) 866-0485 |
| NPI Number | 1558763987 |
|---|---|
| Provider Enumeration Date | 09/17/2014 |
| Last Update Date | 09/14/2015 |
| Medicare PECOS PAC ID | 1759682552 |
|---|---|
| Medicare Enrollment ID | O20151221002147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558763987 | NPI | - | NPPES |
| 20052387OA | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01060733A (Indiana) | Primary |
| Provider Name | James G Wakefield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801882345 PECOS PAC ID: 0042287021 Enrollment ID: I20050722000663 |
| Provider Name | Patricia L Benedict |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134455363 PECOS PAC ID: 6901947456 Enrollment ID: I20100106000750 |
| Provider Name | Stephen K Rogers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609879675 PECOS PAC ID: 2567591019 Enrollment ID: I20100521000714 |
| Provider Name | Garry Lee Brady |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1457513764 PECOS PAC ID: 5799931705 Enrollment ID: I20140509001308 |
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