Provider Demographics
NPI:1417031907
Name:DEL PILAR MEDICAL & URGENT CARE PC
Entity Type:Organization
Organization Name:DEL PILAR MEDICAL & URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-271-0268
Mailing Address - Street 1:270 E DAY RD STE 280
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3452
Mailing Address - Country:US
Mailing Address - Phone:574-271-0268
Mailing Address - Fax:574-271-0395
Practice Address - Street 1:270 E DAY RD STE 280
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3452
Practice Address - Country:US
Practice Address - Phone:574-271-0268
Practice Address - Fax:574-271-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001173207Q00000X, 208000000X
IN02001173A207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200332960Medicaid
IN100092300Medicaid
IN000000104315OtherANTHEM BCBS GROUP NUMBER
IN000000104315OtherANTHEM BCBS
IN200332960Medicaid
INE66806Medicare UPIN
IN236030Medicare PIN