Provider Demographics
NPI:1982934642
Name:FAYETTE FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:FAYETTE FAMILY PRACTICE, INC.
Other - Org Name:WILLIAM A. NESBITT, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-827-1800
Mailing Address - Street 1:1550 E STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-8293
Mailing Address - Country:US
Mailing Address - Phone:765-827-1800
Mailing Address - Fax:765-827-1816
Practice Address - Street 1:1550 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-8293
Practice Address - Country:US
Practice Address - Phone:765-827-1800
Practice Address - Fax:765-827-1816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAYETTE FAMILY PRACTICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027130A207Q00000X
IN01027130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200993720AMedicaid
INB28240Medicare UPIN
B28240Medicare UPIN