PROACTIVE MSO LLC NPI 1790223048

NPI Information

  • NPI: 1790223048
  • Provider Name: PROACTIVE MSO, LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Other Name: PROACTIVE MD
  • CLIA Number: 15D2123096
  • Address: 2400 SAGAMORE PKWY S
    LAFAYETTE, IN
    ZIP 47905
  • Phone: (765) 772-4086

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NPI Details

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
1261QP2300XClinic/CenterPrimary CareYes

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: 3/30/2025

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