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General NPI Number Information
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NPI Number | 1114950292
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Entity Type | Organization
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Legal Business Name | MGFW SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 7916 W. JEFFERSON BLVD. STE 100
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City | FORT WAYNE
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State | IN
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Zip | 46804
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Country | US
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Telephone | 260-432-2297
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Fax | 260-434-6420
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Provider Business Mailing Address
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Address Line | PO BOX 2594
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City | FORT WAYNE
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State | IN
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Zip | 46801-2594
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Country | US
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Telephone | 260-432-2297
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Fax | 260-434-6420
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Authorized Official
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Title or Position | CEO
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Name | MR. JOEL R SAUER
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Credential |
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Telephone | 260-432-2297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | IN
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