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General NPI Number Information
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NPI Number | 1700940061
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Entity Type | Organization
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Legal Business Name | NETTLE CREEK HEALTH CARE CENTER PC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 4829 N STATE ROAD 1 SUITE 1
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City | HAGERSTOWN
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State | IN
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Zip | 47346
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Country | US
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Telephone | 765-489-4578
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Fax | 765-489-5135
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | HAGERSTOWN
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State | IN
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Zip | 47346
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Country | US
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Telephone | 765-489-4578
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Fax | 765-489-5135
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIM M WEBER
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Credential | MD
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Telephone | 765-489-4578
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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 | 01045014
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License Number State | IN
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