| Vpchc-clinton Dental | |
|
1792 E State Road 163 Clinton IN 47842-7327 | |
| (765) 828-3241 | |
| Not Available |
| Full Name | Vpchc-clinton Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 1792 E State Road 163, Clinton, Indiana |
| Authorized Official Name and Position | Terry J Warren (PRESIDENT/CEO) |
| Authorized Official Contact | 7658281003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vpchc-clinton Dental 777 S Main St Ste 100 Clinton IN 47842-2493 Ph: (765) 828-1003 | Vpchc-clinton Dental 1792 E State Road 163 Clinton IN 47842-7327 Ph: (765) 828-3241 |
| NPI Number | 1972312973 |
|---|---|
| Provider Enumeration Date | 01/03/2025 |
| Last Update Date | 01/09/2025 |
| Certification Date | 01/09/2025 |
| Medicare PECOS PAC ID | 7618067265 |
|---|---|
| Medicare Enrollment ID | O20250311000919 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972312973 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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