Provider Demographics
NPI:1679775902
Name:KOUTS FAMILY HEALTH CARE, IINC
Entity type:Organization
Organization Name:KOUTS FAMILY HEALTH CARE, IINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-766-3131
Mailing Address - Street 1:705 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-9692
Mailing Address - Country:US
Mailing Address - Phone:219-766-3131
Mailing Address - Fax:219-766-0303
Practice Address - Street 1:705 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KOUTS
Practice Address - State:IN
Practice Address - Zip Code:46347-9692
Practice Address - Country:US
Practice Address - Phone:219-766-3131
Practice Address - Fax:219-766-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28087031A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN141010Medicare PIN