Healthcare Provider Details

I. General information

NPI: 1720115231
Provider Name (Legal Business Name): LITTLE CREEK FAMILY HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 N US HIGHWAY 31 SUITE 10
NEW WHITELAND IN
46184-9767
US

IV. Provider business mailing address

6001 N US HIGHWAY 31 SUITE 10
NEW WHITELAND IN
46184-9767
US

V. Phone/Fax

Practice location:
  • Phone: 317-535-3003
  • Fax: 317-535-6004
Mailing address:
  • Phone: 317-535-3003
  • Fax: 317-535-6004

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: MS. DENA K BARGER
Title or Position: PRESIDENT
Credential: NP
Phone: 317-535-3003