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Organization
HENRY COUNTY MEMORIAL HOSPITAL
Active
Organization
HENRY COUNTY MEMORIAL HOSPITAL
Active
Other names
Centerville Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
CARISSA FULLER CPC (CREDENTIALING COORDINATOR)
(765) 599-3534
Entity
Organization
Contact information
Practice address
4760 NATIONAL RD W, RICHMOND, IN 47374-4745
(765) 965-6679
Mailing address
PO BOX 485, NEW CASTLE, IN 47362-0485
(765) 521-1516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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