Provider Demographics
NPI:1174341887
Name:PROVIDER PARTNERS CARE MANAGEMENT INDIANA LLC
Entity type:Organization
Organization Name:PROVIDER PARTNERS CARE MANAGEMENT INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FLEISCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-241-5063
Mailing Address - Street 1:785 ELKRIDGE LANDING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2958
Mailing Address - Country:US
Mailing Address - Phone:410-967-2097
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1983
Practice Address - Country:US
Practice Address - Phone:443-275-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty