Provider Demographics
NPI:1255439022
Name:DIAGNOSTIC MEDICINE P.C.
Entity type:Organization
Organization Name:DIAGNOSTIC MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:574-936-2643
Mailing Address - Street 1:113 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2132
Mailing Address - Country:US
Mailing Address - Phone:574-936-2643
Mailing Address - Fax:574-540-4001
Practice Address - Street 1:113 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2132
Practice Address - Country:US
Practice Address - Phone:574-250-3178
Practice Address - Fax:574-250-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004231207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110207420OtherMEDICARE RAILROAD
IN200281260Medicaid
IN110207420OtherMEDICARE RAILROAD