Healthcare Provider Details

I. General information

NPI: 1891029237
Provider Name (Legal Business Name): ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 PROVIDENT DR
WARSAW IN
46580-3265
US

IV. Provider business mailing address

2518 E DUPONT RD
FORT WAYNE IN
46825-1675
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-4026
  • Fax: 574-269-7444
Mailing address:
  • Phone: 260-432-4400
  • Fax: 260-969-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIN

VIII. Authorized Official

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