Provider Demographics
NPI:1235775503
Name:PROACTIVE - SOUTH CENTRAL
Entity Type:Organization
Organization Name:PROACTIVE - SOUTH CENTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-645-1892
Mailing Address - Street 1:9808 S 600 W
Mailing Address - Street 2:
Mailing Address - City:UNION MILLS
Mailing Address - State:IN
Mailing Address - Zip Code:46382-9600
Mailing Address - Country:US
Mailing Address - Phone:812-645-1892
Mailing Address - Fax:
Practice Address - Street 1:9808 S 600 W
Practice Address - Street 2:
Practice Address - City:UNION MILLS
Practice Address - State:IN
Practice Address - Zip Code:46382-9600
Practice Address - Country:US
Practice Address - Phone:812-645-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care