Organization
FORT WAYNE ORTHOPAEDICS, LLC
Active
Other names
Fort Wayne Orthopedics, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JERALD L. COOPER M.D. (M.D./PRESIDENT)
(260) 436-8686
Entity
Organization
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 432-5075
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
50002482
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0162610001
DME REGIONB
IN
Enumeration date
05/25/2007
Last updated
07/20/2016
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