Organization
SURGICENTER GROUP LLC
Active
Other names
Fort Wayne Ambulatory Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY S RAPKIN (PART OWNER)
(765) 286-8888
Entity
Organization
Contact information
Practice address
321 E WAYNE ST, FORT WAYNE, IN 46802-2713
(260) 422-5976
(260) 969-1041
Mailing address
PO BOX 457, RICHMOND, IN 47375-0457
(765) 966-1945
(765) 966-2975
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000532877
ANTHEM PIN
IN
05
—
200875480A
—
IN
05
—
2883910
—
OH
Enumeration date
07/05/2006
Last updated
03/12/2009
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