Provider Demographics
NPI:1316011976
Name:CURTIS FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:CURTIS FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANOWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-946-7900
Mailing Address - Street 1:2418 N. CURTIS DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-8818
Mailing Address - Country:US
Mailing Address - Phone:574-946-7900
Mailing Address - Fax:574-946-7936
Practice Address - Street 1:2418 N. CURTIS DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-8818
Practice Address - Country:US
Practice Address - Phone:574-946-7900
Practice Address - Fax:574-946-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000870B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000102868OtherBLUE CROSS / BLUE SHIELD
IN200885120AMedicaid
IN670540Medicare PIN
INE35231Medicare UPIN
IN000000102868OtherBLUE CROSS / BLUE SHIELD