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Proactive Mso, LLC

Organization Active NPI Primary Care Clinic/Center · Vincennes, IN

NPI 1326577396 · NPPES record last updated Mar 25, 2022

Key facts

NPI
1326577396
Entity type
Organization (NPI type 2)
Primary specialty
Primary Care Clinic/Center 261QP2300X
Legal business name
PROACTIVE MSO, LLC
Practice address
1602 Upper 11TH St
Vincennes, IN 47591-4820
Phone
(812) 886-4557
NPI assigned
Jun 5, 2017
Organization subpart
No

Authorized official

Name
Jan Hopkins
Title
Assoc. Ops. MGR
Phone
(864) 501-0751

Corporate family (same tax ID) 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2129135Proactive Vincennes Health Center
1602 N Upper 11TH, Vincennes, IN 47591		Certificate of waiverApr 12, 2027

National Provider Directory

Tax ID family
W Lafayette Health Center (35 organizations share this tax ID)

Locations

1602 Upper 11th St
Vincennes, IN 47591
Phone (812) 886-4557

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Yes

Addresses

Primary practice location

1602 Upper 11TH St
Vincennes, IN 47591-4820

Mailing address

124 Allawood CT
Simpsonville, SC 29681-6207
Phone (864) 501-0751

Other names

  • Proactive MD Vincennes Health Center Doing business as
  • Proactive MD Other name

Other providers in Vincennes, IN

All providers in Vincennes, IN · Primary Care Clinic/Center in Indiana

Sources for this page

Verify at the official NPI Registry.