Provider Demographics
NPI:1962276782
Name:KAIROS CLINIC
Entity type:Organization
Organization Name:KAIROS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH- CAILLOUET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-474-1723
Mailing Address - Street 1:3735 ABNEY POINT DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7706
Mailing Address - Country:US
Mailing Address - Phone:217-414-1723
Mailing Address - Fax:804-282-9133
Practice Address - Street 1:3735 ABNEY POINT DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7706
Practice Address - Country:US
Practice Address - Phone:217-414-1723
Practice Address - Fax:804-282-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty