# QHG OF FORT WAYNE COMPANY LLC

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

## Provider details

- **NPI number:** 1952349896
- **Authorized official:** DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (615) 465-7626

## Contact information

- **Practice address:** 1415 FLAXMILL RD, HUNTINGTON, IN 46750-8806
- **Practice address phone:** (260) 359-1250
- **Mailing address:** 7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 10/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200230770C | — | IN |