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NPI Code Detail

MEDICARE: FORT WAYNE CARDIOLOGY CORPORATION

MEDICARE: FORT WAYNE CARDIOLOGY CORPORATION
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
1207R00000XInternal Medicine Physician
2207RC0001XClinical Cardiac Electrophysiology Physician
3207RG0300XGeriatric Medicine (Internal Medicine) Physician
4207RI0011XInterventional Cardiology Physician
5207RC0000XCardiovascular Disease Physician

General Provider Information

NPI Number : 1134318355
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT WAYNE CARDIOLOGY CORPORATION
Provider Business Mailing Address
First Line : PO BOX 11829
Second Line :
City : FORT WAYNE
State : IN
Zip : 46861-1829
Country : US
Telephone Number : 260-481-4700
Fax Number : 260-481-4808
Provider Business Practice Location Address
First Line : 1819 CAREW ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4705
Country : US
Telephone Number : 260-481-4700
Fax Number : 260-481-4808
Authorized Official
Title or Position : CFO
Name : NANCY SCHROEDER
Credential :
Telephone Number : 260-481-4700
Provider Enumeration Date : 10/24/2007
Last Update Date : 10/07/2008

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Directions to “FORT WAYNE CARDIOLOGY CORPORATION ” Practice Location

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