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Organization
FORT WAYNE MEDICAL EDUCATION PROGRAM
Active
Organization
FORT WAYNE MEDICAL EDUCATION PROGRAM
Active
Other names
The Family Medicine Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY HARRIS COO (CHIEF OPERATING OFFICER)
(260) 423-2682
Entity
Organization
Contact information
Practice address
750 BROADWAY, SUITE 350, FORT WAYNE, IN 46802-1412
(260) 423-2675
(260) 423-6621
Mailing address
750 BROADWAY, SUITE 150, FORT WAYNE, IN 46802-1412
(260) 423-2682
(260) 422-4326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/11/2006
Last updated
04/20/2015
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