| Trustees Of Purdue University | |
|
128 W Market St Wolcott IN 47995-8130 | |
| (219) 747-2067 | |
| (219) 747-2068 |
| Full Name | Trustees Of Purdue University |
|---|---|
| Speciality | Clinic/Center |
| Location | 128 W Market St, Wolcott, 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 128 W Market St Wolcott IN 47995-8130 Ph: (219) 747-2067 |
| NPI Number | 1598111791 |
|---|---|
| Provider Enumeration Date | 05/06/2016 |
| Last Update Date | 04/18/2022 |
| Medicare PECOS PAC ID | 2567373012 |
|---|---|
| Medicare Enrollment ID | O20160902000433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598111791 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Wolcott Family Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 128 W Market Street, Wolcott, IN 47995 Phone: 219-279-2264 Fax: 219-279-2279 |