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General NPI Number Information
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NPI Number | 1578770038
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Entity Type | Organization
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Legal Business Name | ORLEANS MEDICAL CLINIC,LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 155 E MARTIN ST
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City | ORLEANS
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State | IN
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Zip | 47452-9012
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Country | US
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Telephone | 812-865-3400
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Fax | 812-865-4890
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Provider Business Mailing Address
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Address Line | 155 E MARTIN ST
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City | ORLEANS
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State | IN
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Zip | 47452-9012
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Country | US
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Telephone | 812-865-3400
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Fax | 812-865-4890
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE LOPEZ
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Credential | MD
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Telephone | 812-865-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01053941A
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License Number State | IN
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