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General NPI Number Information
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NPI Number | 1992395388
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Entity Type | Organization
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Legal Business Name | IU HEALTH SOUTHWEST FORT WAYNE AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 4105 DICKE ROAD
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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 | 317-201-1038
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Fax |
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Provider Business Mailing Address
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Address Line | 950 N MERIDIAN ST STE 910
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1077
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Country | US
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Telephone | 317-805-2247
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ERIN KOUSAGAN
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Credential |
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Telephone | 504-220-8912
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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 |
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