Organization
FORT WAYNE MEDICAL EDUCATION PROGRAM
Active
Other names
The Family Medicine Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY HARRIS COO (CHIEF OPERATING OFFICER)
(260) 423-2682
Entity
Organization
Contact information
Practice address
750 BROADWAY, SUITE 350, FORT WAYNE, IN 46802-1412
(260) 423-2675
(260) 423-6621
Mailing address
750 BROADWAY, SUITE 150, FORT WAYNE, IN 46802-1412
(260) 423-2682
(260) 422-4326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100050650A
—
IN
Enumeration date
08/11/2006
Last updated
04/20/2015
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