Organization
FORT WAYNE ORTHOPAEDICS, LLC SURGICENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE J BLAIR (CREDENTIAL COORDINATOR)
(260) 436-8686
Entity
Organization
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 432-5075
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 432-5075
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
50002482A
IN
Other
Enumeration date
09/01/2005
Last updated
08/22/2020
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