MEDICARE: PROACTIVE MSO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1174169908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE MSO, LLC

Provider Business Mailing Address
First Line	:	124 ALLAWOOD CT
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-6207
Country	:	US
Telephone Number	:	864-501-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 LAFAYETTE RD STE A
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-4603
Country	:	US
Telephone Number	:	812-645-1945
Fax Number	:

Authorized Official
Title or Position	:	ASSOC. OPS MGR
Name	:	JAN HOPKINS
Credential	:
Telephone Number	:	864-501-0751

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	03/25/2022

Similar Medicare Providers

1376578435 — MRS. TRICIA L STANLEY NURSE PRACTITIONER
Practice Location Address:

1615 US HWY 231 S , SUITE A
CRAWFORDSVILLE, IN
47933-4603

Practice Phone: 765-323-4689
Practice Fax:

1578194767 — LAURAN BETTE NICHOLS FNP-C
Practice Location Address:

1720 LAFAYETTE RD STE A
CRAWFORDSVILLE, IN
47933-4603

Practice Phone: 765-323-2828
Practice Fax:

1164140059 — MADELYNNE GRACE RUNYON MSAT, LAT, ATC
Practice Location Address:

301 W WABASH AVE
CRAWFORDSVILLE, IN
47933-2428

Practice Phone: 765-361-6366
Practice Fax:

1043172695 — STEPHANIE BIECK RBT
Practice Location Address:

2303 PHIL WARD BLVD
CRAWFORDSVILLE, IN
47933-4607

Practice Phone: 317-520-4748
Practice Fax:

1760344311 — KARYSSA POTTERS RBT
Practice Location Address:

2303 PHIL WARD BLVD
CRAWFORDSVILLE, IN
47933-4607

Practice Phone: 317-520-4748
Practice Fax:

1730715756 — CONNOR PARSELL
Practice Location Address:

1710 LAFAYETTE RD
CRAWFORDSVILLE, IN
47933-1033

Practice Phone: 765-364-3132
Practice Fax:

Directions to “PROACTIVE MSO, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.