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General NPI Number Information
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NPI Number | 1770725244
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Entity Type | Organization
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Legal Business Name | CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 2315 BROADWAY
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City | FORT WAYNE
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State | IN
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Zip | 46807-1103
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Country | US
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Telephone | 260-458-8414
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Fax | 260-458-8414
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Provider Business Mailing Address
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Address Line | 2315 BROADWAY
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City | FORT WAYNE
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State | IN
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Zip | 46807-1103
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Country | US
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Telephone | 260-458-8414
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Fax | 260-458-8414
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSIE T. MILNER
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Credential | N.P.
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Telephone | 260-458-8414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 71000514A
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License Number State | IN
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