| Pickerill Personalized Care LLC | |
|
2525 South St Lafayette IN 47904-3028 | |
| (765) 807-2325 | |
| (765) 807-2330 |
| Full Name | Pickerill Personalized Care LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2525 South St, Lafayette, Indiana |
| Authorized Official Name and Position | Casey Lewis Pickerill (PHYSICAN) |
| Authorized Official Contact | 7658072325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pickerill Personalized Care LLC 2525 South St Lafayette IN 47904-3028 Ph: (765) 807-2325 | Pickerill Personalized Care LLC 2525 South St Lafayette IN 47904-3028 Ph: (765) 807-2325 |
| NPI Number | 1639987746 |
|---|---|
| Provider Enumeration Date | 12/20/2024 |
| Last Update Date | 12/20/2024 |
| Certification Date | 12/20/2024 |
| Medicare PECOS PAC ID | 7012412554 |
|---|---|
| Medicare Enrollment ID | O20250925000631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639987746 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Casey L Pickerill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164491759 PECOS PAC ID: 1355300443 Enrollment ID: I20041005000682 |
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