# QHG OF FORT WAYNE COMPANY LLC

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

## Provider details

- **NPI number:** 1619918026
- **Authorized official:** KRISTINA MUSIC (DIRECTOR, PROVIDER ENROLLMENT)
- **Authorized official phone:** (615) 465-7377

## Contact information

- **Practice address:** 7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6280
- **Practice address phone:** (260) 458-3843
- **Practice address fax:** (260) 637-1601
- **Mailing address:** PO BOX 689022, FRANKLIN, TN 37068-9022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 10/01/2024