Healthcare Provider Details

I. General information

NPI: 1811074982
Provider Name (Legal Business Name): HENRY COUNTY URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SOUTH MEMORIAL DRIVE
NEW CASTLE IN
47362-4947
US

IV. Provider business mailing address

PO BOX 337
NEW CASTLE IN
47362-0337
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-1366
  • Fax: 765-521-1555
Mailing address:
  • Phone: 765-521-1366
  • Fax: 765-521-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. PAUL F JANSSEN
Title or Position: PRESIDENT
Credential:
Phone: 765-521-1508