OrganizationActive
Innovative Medicine
NPI 1417486523 · Addiction Medicine (Family Medicine) Physician · Lafayette, IN
Provider details
- NPI number
- 1417486523
- Entity type
- Organization
- Primary specialty
- Addiction Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jacqueline Snyder, Billing Manager(765) 413-7100
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Non-Pharmacy Dispensing Site332900000X
Suppliers
- Adult Medicine Physician207QA0505X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
3554 Promenade Pkwy Ste H
Lafayette, IN 47909-8418
Phone: (765) 471-1100
Fax: (765) 471-1009
Approximate (ZIP-level) locationGet directions
Mailing address
3554 Promenade Pkwy Ste H
Lafayette, IN 47909-8418
Registry dates
- Enumerated
- 2017-06-12
- Last updated
- 2024-04-18
- Certified
- 2024-04-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.