Provider Demographics
NPI:1528094950
Name:ADAMS COUNTY FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:ADAMS COUNTY FAMILY PRACTICE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRESLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-724-2125
Mailing Address - Street 1:955 HIGH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2326
Mailing Address - Country:US
Mailing Address - Phone:260-724-2125
Mailing Address - Fax:260-724-3859
Practice Address - Street 1:955 HIGH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2326
Practice Address - Country:US
Practice Address - Phone:260-724-2125
Practice Address - Fax:260-724-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
401780Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER