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NPI Code Detail

MEDICARE: MINUTECLINIC DIAGNOSTICS OF INDIANA, LLC

MEDICARE: MINUTECLINIC DIAGNOSTICS OF INDIANA, 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
1101YP2500XProfessional Counselor
21041C0700XClinical Social Worker
3106H00000XMarriage & Family Therapist
4363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1932171634
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINUTECLINIC DIAGNOSTICS OF INDIANA, LLC
Provider Business Mailing Address
First Line : PO BOX 772
Second Line : MINUTECLINIC CREDENTIALING
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Provider Business Practice Location Address
First Line : 1466 W OAK ST
Second Line :
City : ZIONSVILLE
State : IN
Zip : 46077-1800
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEBORAH JEAN PINCINCE
Credential :
Telephone Number : 401-770-3813
Provider Enumeration Date : 02/06/2006
Last Update Date : 07/24/2024

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