Organization
W. LAFAYETTE HEALTH CENTER
Active
Parent organization
PROACTIVE MSO, LLC
Other names
Lafayette DPC-1
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROACTIVE MSO, LLC
Authorized official
MARK KEMBLE MD (VP OF MEDICAL AFFAIRS)
(864) 501-0815
Entity
Organization
Contact information
Practice address
2701B KENT AVE, W LAFAYETTE, IN 47906-1350
(812) 308-8400
(765) 600-9796
Mailing address
10 CENTIMETERS DR, MAULDIN, SC 29662-3278
(864) 501-0751
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/27/2020
Last updated
09/28/2020
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