Provider Demographics
NPI:1366703399
Name:DEXTER HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:DEXTER HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:574-722-5678
Mailing Address - Street 1:800 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1577
Mailing Address - Country:US
Mailing Address - Phone:574-722-5678
Mailing Address - Fax:574-753-5597
Practice Address - Street 1:800 FULTON ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1577
Practice Address - Country:US
Practice Address - Phone:574-722-5678
Practice Address - Fax:574-753-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCFM00432335E00000X
INCFTS0099335E00000X
IN69000792A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100175590AMedicaid
0317180001Medicare NSC