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General NPI Number Information
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NPI Number | 1174341887
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Entity Type | Organization
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Legal Business Name | PROVIDER PARTNERS CARE MANAGEMENT INDIANA LLC
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 800 SAINT JOSEPH DR
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City | KOKOMO
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State | IN
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Zip | 46901-1983
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Country | US
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Telephone | 443-275-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 785 ELKRIDGE LANDING RD STE 300
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City | LINTHICUM HEIGHTS
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State | MD
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Zip | 21090-2958
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Country | US
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Telephone | 410-967-2097
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. CRAIG ALLEN FLEISCHMANN
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Credential |
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Telephone | 410-241-5063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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