Organization
SYCAMORE SPRINGS, LLC
Active
Parent organization
SYCAMORE SPRINGS, LLC
Other names
Sycamore Springs
Organization subpart
Yes
Provider details
NPI number
Legal business name
SYCAMORE SPRINGS, LLC
Authorized official
MS. DONNA SALEE WEST RN (DIRECTOR OF LICENSE AND REGULATION)
(812) 598-8989
Entity
Organization
Contact information
Practice address
833 PARK EAST BLVD, LAFAYETTE, IN 47905-0785
(765) 743-4400
(765) 743-4411
Mailing address
833 PARK EAST BLVD, LAFAYETTE, IN 47905-0785
(765) 743-4400
(765) 743-4411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01044009A
IN
207Q00000X
Family Medicine Physician
02002841A
IN
2084P0800X
Psychiatry Physician
Primary
01044028B
IN
363LA2200X
Adult Health Nurse Practitioner
28150957A
IN
363LF0000X
Family Nurse Practitioner
28119850A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01044009A
LICENSE NUMBER
IN
01
—
01044028B
LICENSE NUMBER
IN
01
—
02002841A
LICENSE NUMBER
IN
01
—
28119850A
LICENSE NUMBER
IN
01
—
28150957A
LICENSE NUMBER
IN
Enumeration date
11/05/2013
Last updated
11/05/2013
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