# FORT WAYNE MEDICAL EDUCATION PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Family Medicine Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184635153
- **Authorized official:** KIMBERLY HARRIS COO (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (260) 423-2682

## Contact information

- **Practice address:** 750 BROADWAY, SUITE 350, FORT WAYNE, IN 46802-1412
- **Practice address phone:** (260) 423-2675
- **Practice address fax:** (260) 423-6621
- **Mailing address:** 750 BROADWAY, SUITE 150, FORT WAYNE, IN 46802-1412
- **Mailing address phone:** (260) 423-2682
- **Mailing address fax:** (260) 422-4326

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 04/20/2015