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General NPI Number Information
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NPI Number | 1629250618
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Entity Type | Organization
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Legal Business Name | WESTCENTRAL INDIANA NEONATAL GROUP
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 501 N 3RD ST
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City | LAFAYETTE
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State | IN
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Zip | 47901-1001
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Country | US
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Telephone | 765-747-4503
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Fax | 765-742-6883
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Provider Business Mailing Address
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Address Line | 501 N 3RD ST
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City | LAFAYETTE
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State | IN
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Zip | 47901-1001
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Country | US
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Telephone | 765-747-4503
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Fax | 765-742-6883
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CYNTHIA STRONG
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Credential |
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Telephone | 765-742-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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