Provider Demographics
NPI:1821709031
Name:PROACTIVE CLINICAL PARTNERS - ACO
Entity Type:Organization
Organization Name:PROACTIVE CLINICAL PARTNERS - ACO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-798-5688
Mailing Address - Street 1:2485 DIRECTORS ROW STE D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4907
Mailing Address - Country:US
Mailing Address - Phone:317-941-7338
Mailing Address - Fax:317-969-6727
Practice Address - Street 1:2485 DIRECTORS ROW STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4907
Practice Address - Country:US
Practice Address - Phone:317-941-7338
Practice Address - Fax:317-969-6727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROACTIVE CLINICAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-08
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty