Provider Demographics
NPI:1578770038
Name:ORLEANS MEDICAL CLINIC,LLC
Entity Type:Organization
Organization Name:ORLEANS MEDICAL CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-865-3400
Mailing Address - Street 1:155 E MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452-9012
Mailing Address - Country:US
Mailing Address - Phone:812-865-3400
Mailing Address - Fax:812-865-4890
Practice Address - Street 1:155 E MARTIN ST
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452-9012
Practice Address - Country:US
Practice Address - Phone:812-865-3400
Practice Address - Fax:812-865-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053941A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH42958Medicare UPIN
IN232180AMedicare ID - Type Unspecified