Healthcare Provider Details

I. General information

NPI: 1710275664
Provider Name (Legal Business Name): LUTHERAN MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 BROOKLYN AVE
FORT WAYNE IN
46809-1361
US

IV. Provider business mailing address

PO BOX 4852
BELFAST ME
04915-4852
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-2297
  • Fax:
Mailing address:
  • Phone: 877-848-1463
  • Fax: 615-925-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KRISTY MUSIC
Title or Position: DIRECTOR
Credential:
Phone: 877-892-9815