# VA NORTHERN INDIANA HEALTH CARE SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386028330
- **Authorized official:** RICHARD HAYES (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (260) 426-5431

## Contact information

- **Practice address:** 2121 LAKE AVE, FORT WAYNE, IN 46805-5100
- **Practice address phone:** (260) 426-5431
- **Mailing address:** 4374 COUNTY ROAD 233, CLYDE, OH 43410-9750
- **Mailing address phone:** (419) 463-0025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QV0200X | VA Clinic/Center | 03233198 | OH | Yes |

## Other

- **Enumeration date:** 07/18/2015
- **Last updated:** 07/18/2015