| Promed Preferred In Pc | |
|
615 Ferry St Fl 1 Lafayette IN 47901-1143 | |
| (615) 499-3165 | |
| Not Available |
| Full Name | Promed Preferred In Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 615 Ferry St Fl 1, Lafayette, Indiana |
| Authorized Official Name and Position | Lev Grinman (PRESIDENT) |
| Authorized Official Contact | 6154993165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promed Preferred In Pc 329 S Oyster Bay Rd # 2059 Plainview NY 11803-3301 Ph: () - | Promed Preferred In Pc 615 Ferry St Fl 1 Lafayette IN 47901-1143 Ph: (615) 499-3165 |
| NPI Number | 1336945336 |
|---|---|
| Provider Enumeration Date | 02/20/2025 |
| Last Update Date | 02/20/2025 |
| Medicare PECOS PAC ID | 3072038934 |
|---|---|
| Medicare Enrollment ID | O20250423002005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336945336 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Alicia Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902410111 PECOS PAC ID: 5294155479 Enrollment ID: I20220401001875 |
| Provider Name | Suzanne Sharon Burlage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497148266 PECOS PAC ID: 8224343892 Enrollment ID: I20250514001673 |
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