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General NPI Number Information
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NPI Number | 1316550445
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Entity Type | Organization
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Legal Business Name | INDIANA UNIVERSITY HEALTH FORT WAYNE PHYSICIANS, LLC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 2401 W UNIVERSITY AVE
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City | MUNCIE
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State | IN
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Zip | 47303-3428
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Country | US
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Telephone | 765-747-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone | 888-484-3258
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JONATHAN W. VANATOR
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Credential |
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Telephone | 317-963-3395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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