Provider Demographics
NPI:1720115231
Name:LITTLE CREEK FAMILY HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:LITTLE CREEK FAMILY HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-535-3003
Mailing Address - Street 1:6001 N US HIGHWAY 31
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NEW WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-9767
Mailing Address - Country:US
Mailing Address - Phone:317-535-3003
Mailing Address - Fax:317-535-6004
Practice Address - Street 1:6001 N US HIGHWAY 31
Practice Address - Street 2:SUITE 10
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-9767
Practice Address - Country:US
Practice Address - Phone:317-535-3003
Practice Address - Fax:317-535-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224130Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER