TESS LACIE EDVARDSEN (NPI# 1891222808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891222808 |
| Entity Type | Individual |
| Full Name | TESS LACIE EDVARDSEN |
| Credential | DO |
| Practice Address |
611 East Douglas Rd, Ste 407 Family Medicine Center of Sjrmc Mishawaka IN 46545-1468 |
| Mailing Address |
707 E Cedar St, Ste 200 Saint Joseph Physician Network South Bend IN 46617-2057 |
| Practice Telephone | 5743356500 |
| Practice Fax Number | 5743350771 |
| Mailing Telephone | 5743358700 |
| Mailing Fax Number | 5743350741 |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-05-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | PENDING | IN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | STATE LICENSE | PENDING | 01 |
| Street Address |
611 EAST DOUGLAS RD, STE 407 FAMILY MEDICINE CENTER OF SJRMC |
| City | MISHAWAKA |
| State | IN |
| Zip Code | 46545-1468 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649824103 | Senior Helpers | In Home Supportive Care | 230 Catalpa Drive Suite B, Mishawaka, IN 46545 | 2019-08-01 |
| 1093272114 | Candice Marie Greathouse | Physical Therapy Assistant | 3630 Hickory Road, Mishawaka, IN 46545 | 2019-02-25 |
| 1639662596 | Mishawaka Rcf Lp | Assisted Living Facility | 3630 Hickory Rd, Mishawaka, IN 46545 | 2018-06-14 |
| 1760907299 | Timothy John Howard | Emergency Medicine | 610 1/2 N Main Street, Apartment 1, Mishawaka, IN 46545 | 2017-08-05 |
| 1699203612 | Paridhie Vasudevan | Dentist | 6502 Grape Rd Ste 882, Mishawaka, IN 46545 | 2017-06-03 |
| 1780134650 | Ossip Optometry, PC | Optometrist | 5111 N. Main Street, Suite 200, Mishawaka, IN 46545 | 2016-10-04 |
| 1457730038 | Melissa Anne Douthit | Nurse Practitioner | 3665 Park Pl W Ste 300, Mishawaka, IN 46545 | 2015-05-28 |
| 1558759654 | Spine and Joint Associates of Plymouth, Inc | Chiropractor | 229 Red Coach, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1609264795 | Spine and Joint Associates of Mishawaka, Inc | Chiropractor | 229 Red Coach Trail, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1508260795 | Maribel Smith | Counselor | 2989 Heritage Ct, Mishawaka, IN 46545 | 2014-10-16 |
| Find all providers in zip 46545 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780070755 | Joseph John Bartush | Family Medicine | 1540 Trinity Pl, Mishawaka, IN 46545-5006 | 2015-04-07 |
| 1285048835 | Bethany Perrin | Family Medicine | 611 E. Douglas Rd, Ste 407, Mishawaka, IN 46545-1468 | 2014-06-11 |
| 1114347457 | Lynn Day | Family Medicine | 5209 Breezewood Dr, Mishawaka, IN 46544-4161 | 2014-04-25 |
| 1710325386 | Brigitte R Selio | Family Medicine | 611 E Douglas Rd Ste 407, Mishawaka, IN 46545-1468 | 2013-06-05 |
| 1689938664 | Christopher Jordan | Family Medicine | 611 E Douglas Rd Ste 137, Mishawaka, IN 46545-1464 | 2012-06-25 |
| 1417265349 | Patel Familymedicine | Family Medicine | 1625 Jefferson Ave, Mishawaka, IN 46545 | 2010-09-14 |
| 1023251337 | Josephine Schimizzi | Family Medicine | 1505 South Spring Street, Mishawaka, IN 46544 | 2009-04-16 |
| 1972776938 | Mishawaka Clinic, P.C. | Family Medicine | 303 S. Main St., Suite 212, Mishawaka, IN 46544 | 2008-04-10 |
| 1275755100 | Muhammad S. Arain | Family Medicine | St.joseph Va Clinic, 1540 Trinity Place, Mishawaka, IN 46545 | 2007-05-02 |
| 1336271253 | Mishawaka Osteopathic Clinic | Family Medicine | 1207 Lincoln Way West, Mishawaka, IN 46544 | 2007-03-09 |
| Find all providers in MISHAWAKA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.