Nwi Mdvip Llc

LBN: Nwi Mdvip Llc
Nwi Mdvip Llc is an health care organization with primary practice located at 9150 E 109Th Ave Ste 2B , Crown Point IN 46307-7686. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Nwi Mdvip Llc can be contacted via phone (219) 213-2947, or through Jacobus, Brent A via phone (219) 306-0752.

Contact Information

Primary practice address
9150 E 109Th Ave Ste 2B Crown Point IN 46307-7686
Phone: (219) 213-2947
Fax: (219) 310-8175
Website:
Map and Directions
Authorized official contact:
Name: Jacobus, Brent A Doctor of Osteopathy (DO)
Phone: (219) 306-0752

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1538877972
LBN Legal business name Nwi Mdvip Llc
DBA Doing business as
Authorized official Jacobus, Brent A Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 14th, 2022
Last updated Nov 14th, 2022 - about 2 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 1538877972 NPPES
Indiana MEDICAID 200380090
Indiana MEDICAID 100200720

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