MEDICARE: HENRY COUNTY URGENT CARE 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	207Q00000X	Family Medicine Physician		IN

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
2	000000224292	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1811074982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY COUNTY URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-0337
Country	:	US
Telephone Number	:	765-521-1366
Fax Number	:	765-521-1555

Provider Business Practice Location Address
First Line	:	113 SOUTH MEMORIAL DRIVE
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-4947
Country	:	US
Telephone Number	:	765-521-1366
Fax Number	:	765-521-1555

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL F JANSSEN
Credential	:
Telephone Number	:	765-521-1508

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/07/2009

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Directions to “HENRY COUNTY URGENT CARE LLC ” Practice Location

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