Provider Demographics
NPI:1083819957
Name:CHARISM CENTER, LLC
Entity Type:Organization
Organization Name:CHARISM CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-753-8000
Mailing Address - Street 1:101 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-3427
Mailing Address - Country:US
Mailing Address - Phone:574-753-8000
Mailing Address - Fax:574-753-8003
Practice Address - Street 1:101 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-3427
Practice Address - Country:US
Practice Address - Phone:574-753-8000
Practice Address - Fax:574-753-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057949A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000386275OtherANTHEM
INE67518Medicare UPIN
IN233930Medicare ID - Type UnspecifiedCHARISM CENTER PROVIDER #