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General NPI Number Information
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NPI Number | 1528044625
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Entity Type | Organization
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Legal Business Name | INDIANA SURGICAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 11141 PARKVIEW PLAZA DR STE 305
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City | FORT WAYNE
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State | IN
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Zip | 46845-1715
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Country | US
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Telephone | 260-484-9611
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Fax | 260-484-1004
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Provider Business Mailing Address
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Address Line | 11141 PARKVIEW PLAZA DR STE 305
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City | FORT WAYNE
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State | IN
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Zip | 46845-1715
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Country | US
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Telephone | 260-484-9611
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Fax | 260-484-1004
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | RICHARD HIVELY
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Credential |
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Telephone | 260-484-9612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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