PROACTIVE MSO LLC NPI 1790223048

NPI Information

NPI: 1790223048
Provider Name: PROACTIVE MSO, LLC

Other Name: PROACTIVE MD

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
2400 SAGAMORE PKWY S
LAFAYETTE, IN
ZIP 47905
Phone: (765) 772-4086
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PROACTIVE MSO, LLC is a primary care clinic center in Lafayette, IN. PROACTIVE MSO, LLC NPI is 1790223048. The provider is registered as an organization entity type.
The provider Other Name Is Proactive Md.

The provider's business location address is:

2400 SAGAMORE PKWY S
LAFAYETTE, IN
ZIP 47905-116
Phone: (765) 772-4086

The provider's authorized official is Jan Hopkins .
The authorized official title is Assoc. Ops Mgr and has the following contact phone number (864) 501-0751.

The CLIA number assigned to this NPI record is 15D2123096 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/7/2017 and was last updated on 3/25/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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