Organization
SUPER SHOT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE HEFLIN (EXECUTIVE DIRECTOR)
(260) 424-7468
Entity
Organization
Contact information
Practice address
1515 HOBSON RD, FORT WAYNE, IN 46805-4802
(260) 424-7468
(260) 739-5623
Mailing address
1515 HOBSON RD, FORT WAYNE, IN 46805-4802
(260) 424-7468
(260) 739-5623
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
N/A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200977620A
—
IN
Enumeration date
04/05/2010
Last updated
05/08/2024
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