Provider Demographics
NPI:1861447211
Name:LAFAYETTE EMERGENCY CARE, P.C.
Entity Type:Organization
Organization Name:LAFAYETTE EMERGENCY CARE, P.C.
Other - Org Name:INDIANA EMERGENCY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO-CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-446-0170
Mailing Address - Street 1:3652 ROME DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4465
Mailing Address - Country:US
Mailing Address - Phone:765-446-0170
Mailing Address - Fax:765-446-9279
Practice Address - Street 1:5165 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-838-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100464230Medicaid
IN100464230Medicaid