DEDICATED FAMILY HEALTH NPI 1144797986

NPI Information

NPI: 1144797986
Provider Name: DEDICATED FAMILY HEALTH
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 15D2184672

Address:
117 N MAIN ST
HEBRON, IN
ZIP 46341
Phone: (219) 509-3383
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DEDICATED FAMILY HEALTH is a family nurse practitioner in Hebron, IN. DEDICATED FAMILY HEALTH NPI is 1144797986. The provider is registered as an organization entity type.

The provider's business location address is:

117 N MAIN ST
HEBRON, IN
ZIP 46341-971
Phone: (219) 509-3383
Fax: (219) 509-3389

The provider's authorized official is Colette H Walter .
The authorized official title is Np, Ceo and has the following contact phone number (219) 509-3383.

The CLIA number assigned to this NPI record is 15D2184672 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/30/2018 and was last updated on 4/16/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			No
2	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1144797986	OTHER	INDIANA	NPI 2
2	201180370	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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