Healthcare Provider Details

I. General information

NPI: 1255630190
Provider Name (Legal Business Name): HEALTHEACCESS CLINICS L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 S BOUNDARY RD
PORTAGE IN
46368-1373
US

IV. Provider business mailing address

6615 S BOUNDARY RD
PORTAGE IN
46368-1373
US

V. Phone/Fax

Practice location:
  • Phone: 219-787-8662
  • Fax:
Mailing address:
  • Phone: 219-787-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003571A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02003571A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number02003571A
License Number StateIN

VIII. Authorized Official

Name: MR. DON KIGER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 219-464-7873