Seelyville Family Practice

LBN: Fountain Of Youth, Llc
Seelyville Family Practice is an health care organization with primary practice located at 8810 Wabash Ave , Terre Haute IN 47803-3908. The organization recently has only one registered license in Ambulatory Health Care Facilities / Clinic/Center, which is considered as the primary health care specialty. Fountain Of Youth, Llc can be contacted via phone (812) 239-4090, or through Jernberg, Sherri via phone (812) 239-4090.

Contact Information

Primary practice address
8810 Wabash Ave Terre Haute IN 47803-3908
Phone: (812) 239-4090
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Jernberg, Sherri Nurse Practitioner (NP)
Phone: (812) 239-4090

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X 71002624A Indiana

Profile Details

NPI number 1316205115
LBN Legal business name Fountain Of Youth, Llc
DBA Doing business as Seelyville Family Practice
Authorized official Jernberg, Sherri Nurse Practitioner (NP)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 30th, 2012
Last updated Apr 30th, 2012 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316205115 NPPES
Indiana Other 1588821250 PERSONAL NPI NUMBER

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