Provider Demographics
NPI:1235201807
Name:FULTON COUNTY MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:FULTON COUNTY MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-223-4337
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-1506
Mailing Address - Country:US
Mailing Address - Phone:574-223-4337
Mailing Address - Fax:574-223-4375
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1506
Practice Address - Country:US
Practice Address - Phone:574-223-4337
Practice Address - Fax:574-223-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386150AMedicaid