Provider Demographics
NPI:1629269345
Name:AFFORDABLE HEALTHCARE OF EAST CENTRAL INDIANA, INC.
Entity Type:Organization
Organization Name:AFFORDABLE HEALTHCARE OF EAST CENTRAL INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:BOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:765-730-0157
Mailing Address - Street 1:7109 N WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-9510
Mailing Address - Country:US
Mailing Address - Phone:765-730-0157
Mailing Address - Fax:765-281-8982
Practice Address - Street 1:7109 N WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-9510
Practice Address - Country:US
Practice Address - Phone:765-730-0157
Practice Address - Fax:765-281-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001195A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty