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Organization

STATE OF INDIANA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ALLEN COLLIER (ASSISTANT SUPERINTENDENT)
(765) 345-5141
Entity
Organization

Contact information

Practice address
10892 N STATE ROAD 140, KNIGHTSTOWN, IN 46148-9769
(765) 345-5141
(765) 345-7412
Mailing address
10892 N STATE ROAD 140, KNIGHTSTOWN, IN 46148-9769
(765) 345-5141
(765) 345-7412

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
STATE OWNED FACILITY
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200074490
IN
Enumeration date
02/26/2008
Last updated
06/19/2008
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