Provider Demographics
NPI:1639987746
Name:PICKERILL PERSONALIZED CARE LLC
Entity type:Organization
Organization Name:PICKERILL PERSONALIZED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PICKERILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-807-2325
Mailing Address - Street 1:2525 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3028
Mailing Address - Country:US
Mailing Address - Phone:765-807-2325
Mailing Address - Fax:765-807-2330
Practice Address - Street 1:2525 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3028
Practice Address - Country:US
Practice Address - Phone:765-807-2325
Practice Address - Fax:765-807-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care