Provider Demographics
NPI:1144797986
Name:DEDICATED FAMILY HEALTH
Entity type:Organization
Organization Name:DEDICATED FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-509-3383
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-8971
Mailing Address - Country:US
Mailing Address - Phone:219-509-3383
Mailing Address - Fax:219-509-3389
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-8971
Practice Address - Country:US
Practice Address - Phone:219-509-3383
Practice Address - Fax:219-509-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1144797986OtherNPI 2
IN201180370Medicaid