Organization
HERITAGE FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETH ANN LOCKWOOD FNP (OWNER)
(574) 248-0630
Entity
Organization
Contact information
Practice address
111 N ELKHART ST, WAKARUSA, IN 46573-2006
(574) 900-1991
(574) 900-1193
Mailing address
PO BOX 106, WAKARUSA, IN 46573-0106
(574) 900-1191
(574) 900-1193
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/22/2024
Last updated
02/22/2024
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