| Proactive Mso, Llc | |
|
725 N State Road 29 Michigantown IN 46057-9615 | |
| (864) 501-0751 | |
| Not Available |
| Full Name | Proactive Mso, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 725 N State Road 29, Michigantown, Indiana |
| Authorized Official Name and Position | Abby Robb Russell (DIRECTOR OF IMPLEMENTATIONS) |
| Authorized Official Contact | 8649005687 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Mso, Llc 124 Allawood Ct Simpsonville SC 29681-6207 Ph: (864) 501-0751 | Proactive Mso, Llc 725 N State Road 29 Michigantown IN 46057-9615 Ph: (864) 501-0751 |
| NPI Number | 1376319087 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376319087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |