Provider Demographics
NPI:1295100667
Name:TOWN SQUARE MEDICAL CLINIC
Entity type:Organization
Organization Name:TOWN SQUARE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-797-2162
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-0543
Mailing Address - Country:US
Mailing Address - Phone:317-797-2162
Mailing Address - Fax:
Practice Address - Street 1:509 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1317
Practice Address - Country:US
Practice Address - Phone:317-797-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care