=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548409543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABERDEEN VENTURES, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2009
-----------------------------------------------------
Last Update Date | 06/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5521 W LINCOLN HWY SUITE 1A
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-1098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-769-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1758 CLIFTY CREEK CT
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46385-6151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-405-9953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & SECRETARY/TREASURER
-----------------------------------------------------
Name | DR. JOHN C JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 219-405-9953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------