Provider Demographics
NPI:1801243688
Name:APEX HEALTHCARE GROUP PC
Entity type:Organization
Organization Name:APEX HEALTHCARE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-314-6436
Mailing Address - Street 1:3665 PARK PL W
Mailing Address - Street 2:SUITE #300
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3566
Mailing Address - Country:US
Mailing Address - Phone:574-314-6436
Mailing Address - Fax:574-485-2984
Practice Address - Street 1:3665 PARK PL W
Practice Address - Street 2:SUITE #300
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3566
Practice Address - Country:US
Practice Address - Phone:574-314-6436
Practice Address - Fax:574-485-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072927A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care