Organization
VA NORTHERN INDIANA HEALTH CARE SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD HAYES (CREDENTIALING SPECIALIST)
(260) 426-5431
Entity
Organization
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
4374 COUNTY ROAD 233, CLYDE, OH 43410-9750
(419) 463-0025
Taxonomy
Speciality
Code
Description
License number
State
261QV0200X
VA Clinic/Center
Primary
03233198
OH
Other
Enumeration date
07/18/2015
Last updated
07/18/2015
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