Provider Demographics
NPI:1437573664
Name:WRIGHT FAMILY PRACTICE
Entity Type:Organization
Organization Name:WRIGHT FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-534-3636
Mailing Address - Street 1:299 E PENDLETON AVE
Mailing Address - Street 2:BX 547
Mailing Address - City:LAPEL
Mailing Address - State:IN
Mailing Address - Zip Code:46051-5546
Mailing Address - Country:US
Mailing Address - Phone:765-534-3636
Mailing Address - Fax:765-534-3638
Practice Address - Street 1:299 E PENDLETON AVE
Practice Address - Street 2:
Practice Address - City:LAPEL
Practice Address - State:IN
Practice Address - Zip Code:46051-5546
Practice Address - Country:US
Practice Address - Phone:765-534-3636
Practice Address - Fax:765-534-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028188B207Q00000X
IN71002634A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D2075563OtherCLIA
IN201248190Medicaid