Provider Demographics
NPI:1568533990
Name:THE CENTRE PC
Entity Type:Organization
Organization Name:THE CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-968-3515
Mailing Address - Street 1:611 E DOUGLAS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1464
Mailing Address - Country:US
Mailing Address - Phone:574-296-9100
Mailing Address - Fax:574-243-1141
Practice Address - Street 1:611 E DOUGLAS RD STE 108
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-968-3515
Practice Address - Fax:574-243-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN228220OtherPTAN 228220 THE CENTRE, LLC