Basic Information
| Provider Information | |||||||||
| NPI: | 1396296703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WECARE TLC - FAIRFIELD HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 SAGAMORE PKWY | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657724086 | ||||||||
| FaxNumber: | 7657724096 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 SAGAMORE PKWY S | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657724086 | ||||||||
| FaxNumber: | 7657724096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2016 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | NATION | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8009410644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.