Provider Demographics
NPI:1861826257
Name:MONTGOMERY COUNTY FREE CLINIC, INC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY FREE CLINIC, INC
Other - Org Name:DR. MARY LUDWIG FREE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOEMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-376-9930
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-0086
Mailing Address - Country:US
Mailing Address - Phone:765-362-3244
Mailing Address - Fax:
Practice Address - Street 1:816 MILL ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3443
Practice Address - Country:US
Practice Address - Phone:765-362-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health