Organization
ENT REALTY CORP
Active
Other names
The Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY THOMPSON (CEO)
(260) 207-1675
Entity
Organization
Contact information
Practice address
7900 W JEFFERSON BLVD, SUITE 102, FORT WAYNE, IN 46804-4128
(260) 432-4368
(260) 436-6283
Mailing address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200138850
—
IN
Enumeration date
12/22/2005
Last updated
11/18/2021
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