Calvary Assembly of God

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CALVARY ASSEMBLY OF GOD

Doing business as

Connection Medical Clinic

Practice address

1317 15TH St. SE
Demotte, IN 46310-9393

Phone

(219) 987-4280

NPI assigned

Sep 30, 2020

Last updated

Feb 26, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Clark

Title

President

Phone

(219) 987-4280

Specialties & licenses 1

Addresses

Other names 1

• Connection Medical Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614297600000",
    "number": "1306453626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 15TH ST SE",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "46310",
            "telephone_number": "219-987-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 15TH ST. SE",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463109393",
            "telephone_number": "219-987-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALVARY ASSEMBLY OF GOD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-987-4280"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connection Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Connection Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Demotte, IN
• Providers in Demotte, IN by specialty
• Primary Care Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.