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General NPI Number Information
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NPI Number | 1144275629
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Entity Type | Organization
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Legal Business Name | FOUNDATION SURGERY AFFILIATE OF FORT WAYNE, LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 8004 CARNEGIE BLVD.
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City | FORT WAYNE
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State | IN
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Zip | 46804-5785
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Country | US
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Telephone | 260-434-3600
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Fax | 260-434-3680
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Provider Business Mailing Address
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Address Line | 8004 CARNEGIE BLVD.
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City | FORT WAYNE
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State | IN
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Zip | 46804-5785
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Country | US
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Telephone | 260-434-3600
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Fax | 260-434-3680
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Authorized Official
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Title or Position | CFO
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Name | MRS. JESSICA LEE-HANSEN
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Credential | N/A
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Telephone | 312-388-0125
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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 | PENDING
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License Number State | IN
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