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General NPI Number Information
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NPI Number | 1942546890
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Entity Type | Organization
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Legal Business Name | PIC INDIANA PC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 505 W CLEVELAND RD
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City | MISHAWAKA
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State | IN
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Zip | 46545-1003
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Country | US
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Telephone | 815-713-2600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | ELLICOTTVILLE
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State | NY
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Zip | 14731-0500
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Country | US
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Telephone | 716-699-9032
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT BIERNBAUM
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Credential | DO
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Telephone | 716-430-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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