Provider Demographics
NPI:1609919778
Name:LIFEPLEX URGENT CARE, L.L.C.
Entity Type:Organization
Organization Name:LIFEPLEX URGENT CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ENP
Authorized Official - Phone:574-941-1000
Mailing Address - Street 1:2855 MILLER DR
Mailing Address - Street 2:STE 119
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8091
Mailing Address - Country:US
Mailing Address - Phone:574-941-1000
Mailing Address - Fax:574-941-1075
Practice Address - Street 1:2855 MILLER DR
Practice Address - Street 2:STE 119
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8091
Practice Address - Country:US
Practice Address - Phone:574-941-1000
Practice Address - Fax:574-941-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200861600AMedicaid
IN249930Medicare PIN