Healthcare Provider Details

I. General information

NPI: 1447634449
Provider Name (Legal Business Name): ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E DUPONT RD SUITE 200
FORT WAYNE IN
46825-1601
US

IV. Provider business mailing address

2518 E DUPONT RD
FORT WAYNE IN
46825-1675
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-4913
  • Fax: 260-969-6832
Mailing address:
  • Phone: 260-432-4400
  • Fax: 260-969-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01065437A
License Number StateIN

VIII. Authorized Official

Name: TRISH WARREN
Title or Position: CFO
Credential:
Phone: 260-432-4400