Healthcare Provider Details

I. General information

NPI: 1871706143
Provider Name (Legal Business Name): OBASEKI INDIANA FAMILY HEALTH CLINIC, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E MAIN ST
WASHINGTON IN
47501-3031
US

IV. Provider business mailing address

1110 E MAIN ST
WASHINGTON IN
47501-3031
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2311
  • Fax:
Mailing address:
  • Phone: 812-254-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number01039780A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000903A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01027289
License Number StateIN

VIII. Authorized Official

Name: LINDA KAY OBASEKI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 812-254-2311