North Central Indiana Medical Clinic LLC
Organization Active NPI Gynecology Physician · Milford, IN
NPI 1730713017 · NPPES record last updated Aug 6, 2020
Key facts
- NPI
- 1730713017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gynecology Physician 207VG0400X
- Legal business name
- NORTH CENTRAL INDIANA MEDICAL CLINIC LLC
- Practice address
- 112 S Main St
Milford, IN 46542-3006 - Phone
- (574) 832-6246
- NPI assigned
- Feb 26, 2020
- Organization subpart
- No
Authorized official
- Name
- Michelle Wilson
- Title
- Practice Manager
- Phone
- (574) 832-6246
Practitioners 4
-
Kimberly Ann Senders, RN-BSN, NP
-
Michelle Wilson, CST, CSFA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2180277 | North Central Indiana Medical Clinic | Certificate of waiver | Mar 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200813002572 | IN | Part B Supplier - Clinic/Group Practice | 4789000340 |
Receives reassigned benefits from 3 practitioners Practice locations: Milford, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician |
207VG0400X | Yes |
Addresses
Primary practice location
112 S Main St
Milford, IN 46542-3006
Mailing address
PO Box 247
Milford, IN 46542-0247
Phone (574) 832-6246
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902-89-0718 | Other | IN | OB/GYN |
Other providers in Milford, IN
- Rebecca J. Johnson
- Laura Kiefer
- Heather J Lechlitner
- Jessica Mae Martin
- Milford Family Physicians, LLP
- Pillbox Pharmacies, Inc.
- Kimberly Ann Senders
- S Douglas Strycker
- Transcending Caregiving Services LLC
- Warsaw Health System, LLC
All providers in Milford, IN · Gynecology 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 Aug 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.