Wolcott Family Medicine, LLC
Organization Active NPI Family Medicine Physician · Wolcott, IN
NPI 1497946818 · NPPES record last updated Sep 30, 2010
Key facts
- NPI
- 1497946818
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01027166A (IN)
- Legal business name
- WOLCOTT FAMILY MEDICINE, LLC
- Practice address
- 128 W Market Street
Wolcott, IN 47995 - Phone
- (219) 279-2264
- Fax
- (219) 279-2279
- NPI assigned
- Aug 9, 2007
- Organization subpart
- No
Authorized official
- Name
- James K Shields, MD
- Title
- Owner/Physician
- Phone
- (219) 279-2264
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 01027166A | IN | Yes |
Addresses
Primary practice location
128 W Market Street
Wolcott, IN 47995
Mailing address
PO Box 4699
Lafayette, IN 47903-4699
Phone (219) 279-2264
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100196860 | Medicaid | IN |
Other providers in Wolcott, IN
- Rosanne R Griggs
- James K Shields
- Town of Wolcott
- Tri-County School Corporation
- Trustees of Purdue University
All providers in Wolcott, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.