| Northridge Medical Group | |
|
1704 Lafayette Rd Crawfordsville IN 47933-1071 | |
| (765) 364-1252 | |
| Not Available |
| Full Name | Northridge Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1704 Lafayette Rd, Crawfordsville, Indiana |
| Authorized Official Name and Position | Jim Siemers (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7653622800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northridge Medical Group 1710 Lafayette Rd Crawfordsville IN 47933-1033 Ph: (765) 361-3012 | Northridge Medical Group 1704 Lafayette Rd Crawfordsville IN 47933-1071 Ph: (765) 364-1252 |
| NPI Number | 1801961255 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 07/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801961255 | NPI | - | NPPES |
| 100389570A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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