Provider Demographics
NPI:1346430832
Name:MUNCIE FAMILY MEDICINE
Entity Type:Organization
Organization Name:MUNCIE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-213-2234
Mailing Address - Street 1:503 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4447
Mailing Address - Country:US
Mailing Address - Phone:765-213-2234
Mailing Address - Fax:765-282-5231
Practice Address - Street 1:503 S TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4447
Practice Address - Country:US
Practice Address - Phone:765-213-2234
Practice Address - Fax:765-282-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042668207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200064040Medicaid
IN200064040Medicaid
IN220200Medicare PIN