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Organization
FAWVER WALDO CLINIC LLP
Active
Organization
FAWVER WALDO CLINIC LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY D FAWVER MD (MANAGING PARTNER)
(260) 436-4060
Entity
Organization
Contact information
Practice address
6920 POINTE INVERNESS WAY, SUITE 250, FORT WAYNE, IN 46804-7926
(260) 436-4060
(260) 436-5713
Mailing address
6920 POINTE INVERNESS WAY, SUITE 250, FORT WAYNE, IN 46804-7926
(260) 436-4060
(260) 436-5713
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD0871
RR MEDICARE
—
Enumeration date
08/15/2006
Last updated
09/11/2025
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