Healthcare Provider Details

I. General information

NPI: 1295749117
Provider Name (Legal Business Name): FT WAYNE CARDIAC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD STE. 120
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

PO BOX 2588
FORT WAYNE IN
46801-2588
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-2297
  • Fax: 260-436-4380
Mailing address:
  • Phone: 260-432-2297
  • Fax: 260-436-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL SAUER
Title or Position: MEMBER
Credential:
Phone: 260-432-2297