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Proactive Mso, LLC

Organization Active NPI Primary Care Clinic/Center · Terre Haute, IN

NPI 1457078321 · NPPES record last updated Oct 21, 2022

Key facts

NPI
1457078321
Entity type
Organization (NPI type 2)
Primary specialty
Primary Care Clinic/Center 261QP2300X
Legal business name
PROACTIVE MSO, LLC
Practice address
3250 Maple Ave
Terre Haute, IN 47804-1727
Phone
(812) 462-5799
NPI assigned
Oct 21, 2022
Organization subpart
No

Authorized official

Name
Jan Maria Hopkins
Title
Operations Manager
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 3

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
15D2012999Proactive MD VCSC Health Center
3250 Maple Ave, Terre Haute, IN 47804		Certificate of waiverSep 12, 2026

National Provider Directory

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

Locations

3250 Maple Ave
Terre Haute, IN 47804
Phone (812) 462-5799

Specialties & licenses

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

Addresses

Primary practice location

3250 Maple Ave
Terre Haute, IN 47804-1727

Mailing address

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

Other names

  • Proactive MD VIGO County Schools Health Center Doing business as

Other providers in Terre Haute, IN

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

Sources for this page

Verify at the official NPI Registry.