UTLEY CLINICS INC

Provider Demographics

• NPI: 1700926011
• Name: UTLEY CLINICS INC
• Entity Type: Organization
• Organization Name: UTLEY CLINICS INC
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: CYNTHIA
• Authorized Official - Middle Name: LYNN
• Authorized Official - Last Name: UTLEY-BRENEMAN
• Authorized Official - Credentials: DPM
• Authorized Official - Phone: 765-296-9842
• Mailing Address - Street 1: 761 N 900 E
• Mailing Address - City: LAFAYETTE
• Mailing Address - State: IN
• Mailing Address - Zip Code: 47905-7569
• Mailing Address - Country: US
• Mailing Address - Phone: 765-296-9842
• Mailing Address - Fax: 765-296-9842
• Practice Address - Street 1: 720 S 6TH ST
• Practice Address - City: MONTICELLO
• Practice Address - State: IN
• Practice Address - Zip Code: 47960-8182
• Practice Address - Country: US
• Practice Address - Phone: 765-296-9842
• Practice Address - Fax: 765-296-9842
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-07
• Last Update Date: 2018-06-21

Provider Licenses

State	License ID	Taxonomies
IN	07000682A	213E00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	0004625100	Other	AETNA
WA	691083	Other	BANKERS LIFE AND CASUALTY
MD	000185153	Other	APWU
IN	000000016511	Other	SENIOR SMART CHOICE
IN	000000196527	Other	BLUE CROSS BLUE SHIELD
IN	100129410A	Medicaid
GA	480007608	Other	PALMETTO GBA - RAILROAD M
IN	00019652701	Other	IN COMP HEALTH
IN	407560	Other	MEDICARE PTAN
IN	000000016511	Other	MPLAN
IN	1275	Other	ARNETT
IA	=========	Other	AMERICAN REPUBLIC
TX	=========	Other	STANDARD LIFE
MD	000185153	Other	APWU
UT	=========	Other	UNITED HEALTHCARE
WI	=========47905A001	Other	TRICARE
IN	000000016511	Other	MPLAN
WA	691083	Other	BANKERS LIFE AND CASUALTY
VI	=========	Other	NALC