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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Stacey McKenzie | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1023418530 | [sources] | |||
| Status | not available | [sources] | |||
| Address | Columbus, IN · Jasper, IN | [sources] | |||
| Last change | Last processed | First seen | |||
Providers who have been terminated for cause from Indiana Medicaid and CHIP.
United States of America · FSSA
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