BLACK CLOVER HOLDINGS LLC NPI 1063397867

NPI Information

  • NPI: 1063397867
  • Provider Name: BLACK CLOVER HOLDINGS LLC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Address: 7225 HERITAGE SQUARE DR STE 240
    GRANGER, IN
    ZIP 46530
  • Phone: (574) 369-9102

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NPI Details

BLACK CLOVER HOLDINGS LLC is a general practice in Granger, IN. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee BLACK CLOVER HOLDINGS LLC NPI is 1063397867. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7225 HERITAGE SQUARE DR STE 240
GRANGER, IN
ZIP 46530-646
Phone: (574) 369-9102

The provider's authorized official is Joshua M Lederer .
The authorized official title is Partner and has the following contact phone number (574) 369-9102.

The enumeration date for this NPI number is 8/11/2025 and was last updated on 8/11/2025.

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
1208D00000XGeneral PracticeYes

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: 11/21/2025

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