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General NPI Number Information
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NPI Number | 1306115282
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Entity Type | Organization
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Legal Business Name | AVON COMMUNITY SCHOOLS WELLNESS CLINIC
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 7203 E US HIGHWAY 36
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City | AVON
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State | IN
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Zip | 46123-7967
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Country | US
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Telephone | 317-544-6135
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Fax | 317-544-6139
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Provider Business Mailing Address
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Address Line | 8244 E US HIGHWAY 36 SUITE 1100
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City | AVON
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State | IN
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Zip | 46123-9575
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Country | US
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Telephone | 317-272-3688
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Fax | 317-272-7515
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Authorized Official
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Title or Position | DIRECTOR IMMEDIATE CARE
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Name | MARIJANE SMALLWOOD
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Credential | RN, MSN, NE-BC
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Telephone | 317-272-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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