MEDICARE: NATIONAL WOMEN'S HEALTH ORGANIZATION OF FORT WAYNE

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
1	174400000X	Specialist	060111354	IN

General Provider Information

NPI Number	:	1053455790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL WOMEN'S HEALTH ORGANIZATION OF FORT WAYNE

Provider Business Mailing Address
First Line	:	2210 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7117
Country	:	US
Telephone Number	:	260-471-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7117
Country	:	US
Telephone Number	:	260-471-5005
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	MRS. ROSA C TILEY
Credential	:
Telephone Number	:	919-783-0444

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	06/20/2008

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