Provider Demographics
NPI:1154086841
Name:DIRECTCLINIC SBC, LLC
Entity Type:Organization
Organization Name:DIRECTCLINIC SBC, LLC
Other - Org Name:DIRECTCLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTHANA KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-750-0418
Mailing Address - Street 1:1355 GETZ RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1609
Mailing Address - Country:US
Mailing Address - Phone:260-212-1900
Mailing Address - Fax:
Practice Address - Street 1:300 W OHIO ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2018
Practice Address - Country:US
Practice Address - Phone:260-212-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care