Organization
WELLCARE FAMILY MEDICINE PC
Active
Other names
WELLCARE FAMILY MEDICINE PC
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
9757 WESTPOINT DR, INDIANAPOLIS, IN 46256-3341
(317) 577-2779
(317) 577-2546
Mailing address
9757 WESTPOINT DR, INDIANAPOLIS, IN 46256-3341
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1535559
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/22/2020
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