| Plaza Park Family Practice Llc | |
|
3799 Venetian Way Newburgh IN 47630-8278 | |
| (812) 471-4302 | |
| (812) 471-4303 |
| Full Name | Plaza Park Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3799 Venetian Way, Newburgh, Indiana |
| Authorized Official Name and Position | Carleen M Rubel (PRESIDENT) |
| Authorized Official Contact | 8124714302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Plaza Park Family Practice Llc Po Box 3276 Evansville IN 47731-3276 Ph: (812) 473-0181 | Plaza Park Family Practice Llc 3799 Venetian Way Newburgh IN 47630-8278 Ph: (812) 471-4302 |
| NPI Number | 1336574490 |
|---|---|
| Provider Enumeration Date | 09/09/2013 |
| Last Update Date | 02/27/2024 |
| Medicare PECOS PAC ID | 4981830585 |
|---|---|
| Medicare Enrollment ID | O20131203001040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336574490 | NPI | - | NPPES |
| DU3406 | Other | IN | RAILROAD MEDICARE |
| 000000840875 | Other | IN | ANTHEM |
| 201195100 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01036788A (Indiana) | Primary |
| 363L00000X | Nurse Practitioner | (Indiana) | Secondary |
| Provider Name | Carleen M Rubel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114904380 PECOS PAC ID: 3971523523 Enrollment ID: I20070409000516 |
| Provider Name | Shannon L Kratzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871821629 PECOS PAC ID: 6800921073 Enrollment ID: I20100914000752 |
| Provider Name | Elise R Schutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215237565 PECOS PAC ID: 6800050493 Enrollment ID: I20120612000010 |
| Provider Name | Courtney N Bender |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538455027 PECOS PAC ID: 0446405682 Enrollment ID: I20140811000879 |
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