MEDICARE: FULTON COUNTY MEDICAL CLINIC PC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235201807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULTON COUNTY MEDICAL CLINIC PC

Provider Business Mailing Address
First Line	:	700 MAIN ST
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-1506
Country	:	US
Telephone Number	:	574-223-4337
Fax Number	:	574-223-4375

Provider Business Practice Location Address
First Line	:	700 MAIN ST
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-1506
Country	:	US
Telephone Number	:	574-223-4337
Fax Number	:	574-223-4375

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DARCI OGLE
Credential	:
Telephone Number	:	574-223-4337

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/04/2013

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