Provider Demographics
NPI:1245742808
Name:FIELD & FOREST MEDICAL, LLC
Entity Type:Organization
Organization Name:FIELD & FOREST MEDICAL, LLC
Other - Org Name:JOHN L WHEAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:WHEAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-592-3399
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0545
Mailing Address - Country:US
Mailing Address - Phone:765-592-3381
Mailing Address - Fax:765-592-3399
Practice Address - Street 1:302 VINE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2161
Practice Address - Country:US
Practice Address - Phone:765-592-3381
Practice Address - Fax:765-820-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078016A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300020656Medicaid
IN000001128857OtherANTHEM