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Organization
QHG OF FORT WAYNE COMPANY LLC
Active
Organization
QHG OF FORT WAYNE COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
1415 FLAXMILL RD, HUNTINGTON, IN 46750-8806
(260) 359-1250
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200230770C
—
IN
Enumeration date
06/03/2006
Last updated
10/14/2008
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