Lake Shore Clinic | |
921 N Lake Shore Dr Culver IN 46511-1207 | |
(574) 842-4330 | |
Not Available |
Full Name | Lake Shore Clinic |
---|---|
Speciality | Clinic/center |
Location | 921 N Lake Shore Dr, Culver, Indiana |
Authorized Official Name and Position | Judith A Deery (BUSINESS MANAGER) |
Authorized Official Contact | 5748423327 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Lake Shore Clinic 921 N Lake Shore Dr Culver IN 46511-1207 Ph: (574) 842-4330 | Lake Shore Clinic 921 N Lake Shore Dr Culver IN 46511-1207 Ph: (574) 842-4330 |
NPI Number | 1366566424 |
---|---|
Provider Enumeration Date | 03/16/2007 |
Last Update Date | 06/21/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366566424 | NPI | - | NPPES |
15D0356500 | Other | IN | CLIA NUMBER |
207Q000000X | Other | IN | TAXONOMY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 207Q000000X (Indiana) | Primary |
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