Olivia Grayce Tack
M.D. | Pediatrics | Female
Olivia Grayce Tack, M.D. is a South Bend, Indiana based Pediatric doctor with medical specialization in
General Pediatrics. Olivia Grayce Tack is also known as
Olivia Grayce Fusillo.
Current practice location of Olivia Grayce Tack is
2235 Cleveland Rd, South Bend, Indiana - 46628-3529. She can be contacted on phone at
574-647-4530 and fax number 574-647-2285.
Olivia Grayce Tack is a sole proprietor of her business.
NPI number (Unique professional ID) for Olivia Grayce Tack is
1255371514 which was assigned by NPPES on 07 Jun, 2006 and it was last updated on 06 Apr, 2021.
Olivia Grayce Tack license number is
01062281A for Pediatrics (208000000X) in Indiana.
Olivia Grayce Tack is a pediatrician who is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Complete Profile:
Olivia Grayce Tack basic information including her official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics |
|---|
| Provider Name : | Olivia Grayce Tack |
|---|
| Other Name : | Olivia Grayce Fusillo |
|---|
| Credential : | M.D. |
|---|
| Gender : | Female |
|---|
Business Address:
Olivia Grayce Tack address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 2235 Cleveland Rd
South Bend, IN, 46628-3529
United States |
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| Phone Number : | 574-647-4530 |
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| Fax Number : | 574-647-2285 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1255371514 |
|---|
| NPI Entity Type : | Individual |
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| First Enrolment Date : | 07 Jun, 2006 |
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| Last Updated On : | 06 Apr, 2021 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Olivia Grayce Tack are as mentioned. Primary taxonomy code for Olivia Grayce Tack, M.D. is
208000000X (Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | Yes | 01062281A | IN |
Legacy Identifiers:
Other legacy medical identifiers of Olivia Grayce Tack such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 200828650 | MEDICAID | IN | |
| 247000031 | Other | IN | MEDICARE PTAN |
Other Practice Locations:
| Practice Address | City, State | Phone Number |
|---|
6913 N MAIN ST STE 200,
GRANGER, IN, 46530-8039
United States | GRANGER, IN | 574-647-4540 |
Endpoints:
Endpoints provide a simple, secure, scalable, and standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. It is used by EHR systems (Electronic Health Records).
| Endpoint Type | Endpoint | Affiliation | Use | Content | Address |
|---|
DIRECT
(Direct Messaging Address) | TACK@mybeacon.cernerdirect.com
| No affiliation |
|
| 2235 CLEVELAND RD,
SOUTH BEND, IN, 46628-3529
United States |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 710 N Niles Ave
South Bend, IN, 46617-1924
United States |
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| Phone Number : | 574-647-1610 |
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| Fax Number : | 574-237-6069 |
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Business Location:
Patients can refer following map for directions to
Olivia Grayce Tack practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.