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General NPI Number Information
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NPI Number | 1962562637
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Entity Type | Organization
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Legal Business Name | CHURUBUSCO FAMILY MEDICINE & URGENT CARE
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 202 WEST WHITLEY STREET
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City | CHURUBUSCO
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State | IN
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Zip | 46723
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Country | US
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Telephone | 260-693-3700
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Fax | 260-693-1005
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Provider Business Mailing Address
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Address Line | 202 WEST WHITLEY STREET
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City | CHURUBUSCO
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State | IN
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Zip | 46723
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Country | US
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Telephone | 260-693-3700
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Fax | 260-693-1005
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JULIE BANNISTER
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Credential |
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Telephone | 260-693-3700
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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 |
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License Number State |
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