Healthcare Provider Details

I. General information

NPI: 1376614370
Provider Name (Legal Business Name): ST CLARE HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

IV. Provider business mailing address

1710 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

V. Phone/Fax

Practice location:
  • Phone: 765-362-2800
  • Fax:
Mailing address:
  • Phone: 765-362-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES M SIEMERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-362-2800