Organization
FC INDIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNI CLEMMONS (CREDENTIALING MANAGER)
(901) 351-1791
Entity
Organization
Contact information
Practice address
2418 16TH ST, BEDFORD, IN 47421-3049
(931) 253-1110
(931) 722-9919
Mailing address
PO BOX 306414, NASHVILLE, TN 37230-6414
(931) 253-1110
(931) 722-9919
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/09/2022
Last updated
09/09/2022
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