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NPI Code Detail

MEDICARE: EMERGENCY PHYSICIANS OF INDIANA PC

MEDICARE: EMERGENCY PHYSICIANS OF INDIANA PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3207P00000XEmergency Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CH7804OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003869454
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMERGENCY PHYSICIANS OF INDIANA PC
Provider Business Mailing Address
First Line : 10351 DAWSONS CREEK BLVD
Second Line : STE D
City : FORT WAYNE
State : IN
Zip : 46825-1904
Country : US
Telephone Number : 260-969-1950
Fax Number : 260-918-2137
Provider Business Practice Location Address
First Line : 1316 E 7TH ST
Second Line :
City : AUBURN
State : IN
Zip : 46706-2523
Country : US
Telephone Number : 800-925-4600
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JOHN WAGEL
Credential : MD
Telephone Number : 800-925-4600
Provider Enumeration Date : 05/18/2006
Last Update Date : 09/11/2014

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Directions to “EMERGENCY PHYSICIANS OF INDIANA PC ” Practice Location

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