| Trustees Of Purdue University | |
|
425 E 5th Street Suite B Burlington IN 46915 | |
| (765) 564-3016 | |
| (765) 564-2608 |
| Full Name | Trustees Of Purdue University |
|---|---|
| Speciality | Clinic/Center |
| Location | 425 E 5th Street, Burlington, 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 901 Prince William Rd Suite A Delphi IN 46923-1758 Ph: (765) 564-3016 | Trustees Of Purdue University 425 E 5th Street Suite B Burlington IN 46915 Ph: (765) 564-3016 |
| NPI Number | 1295104669 |
|---|---|
| Provider Enumeration Date | 09/16/2015 |
| Last Update Date | 04/18/2022 |
| Medicare PECOS PAC ID | 2567373012 |
|---|---|
| Medicare Enrollment ID | O20160226001154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295104669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Wagoner Medical Center, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 605 East 7th Street, Burlington, IN 46915 Phone: 765-566-3351 Fax: 765-566-2250 |