Healthcare Provider Details

I. General information

NPI: 1598795080
Provider Name (Legal Business Name): PRINCETON PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 SHERMAN DRIVE
PRINCETON IN
47670
US

IV. Provider business mailing address

2022 SHERMAN DRIVE
PRINCETON IN
47670
US

V. Phone/Fax

Practice location:
  • Phone: 812-385-1071
  • Fax: 812-385-8793
Mailing address:
  • Phone: 812-385-1071
  • Fax: 812-385-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA L MCELLHINEY
Title or Position: OFFICE MANAGER
Credential: MLT ASCP MT HEW
Phone: 812-385-1071