Healthcare Provider Details
I. General information
NPI: 1558791384
Provider Name (Legal Business Name): LITTLE CLINIC OF IN LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/14/2013
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
815 HIGHLANDER POINT DR
FLOYDS KNOBS IN
47119-9470
US
IV. Provider business mailing address
PO BOX 932958
CLEVELAND OH
44193-0028
US
V. Phone/Fax
- Phone: 812-923-7146
- Fax: 812-923-7157
- Phone: 615-425-4200
- Fax: 615-425-4201
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 201312240A |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 2 | |
| Identifier | 201312240D |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 3 | |
| Identifier | 201312240I |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 4 | |
| Identifier | 201312240J |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 5 | |
| Identifier | 201312240M |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 6 | |
| Identifier | 300000983 |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 7 | |
| Identifier | 201312240F |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 8 | |
| Identifier | 201312240O |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 9 | |
| Identifier | 201312240P |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 10 | |
| Identifier | 300015621 |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 11 | |
| Identifier | 201312240K |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 12 | |
| Identifier | 201312240Q |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 13 | |
| Identifier | 201312240B |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 14 | |
| Identifier | 201312240L |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 15 | |
| Identifier | 201312240N |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 16 | |
| Identifier | 201312240C |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 17 | |
| Identifier | 201312240E |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
VIII. Authorized Official
Name: MR.
THOMAS
SHELLY
Title or Position: VP & GENERAL MANAGER
Credential:
Phone: 615-425-4200
