Organization
NORTHEAST OBSTETRICS & GYNECOLOGY, LLC
Active
Other names
NORTHEAST OB-GYN, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMARA A FURNISS (BUSINESS MANAGER)
(260) 426-7755
Entity
Organization
Contact information
Practice address
11123 PARKVIEW PLAZA DR, SUITE 101, FORT WAYNE, IN 46845-1707
(260) 422-7455
(260) 424-9356
Mailing address
11123 PARKVIEW PLAZA DR, SUITE 101, FORT WAYNE, IN 46845-1707
(260) 422-7455
(260) 424-9356
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
50001834A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100055270A
—
IN
Enumeration date
05/20/2006
Last updated
06/24/2008
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