MEDICARE: FOUNDATION SURGERY AFFILIATE OF FORT WAYNE, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	PENDING	IN

General Provider Information

NPI Number	:	1144275629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION SURGERY AFFILIATE OF FORT WAYNE, LLC

Provider Business Mailing Address
First Line	:	8004 CARNEGIE BLVD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5785
Country	:	US
Telephone Number	:	260-434-3600
Fax Number	:	260-434-3680

Provider Business Practice Location Address
First Line	:	8004 CARNEGIE BLVD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5785
Country	:	US
Telephone Number	:	260-434-3600
Fax Number	:	260-434-3680

Authorized Official
Title or Position	:	ACFO
Name	:	MR. STANTON RISSER
Credential	:	N/A
Telephone Number	:	260-266-9380

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/27/2025

Similar Medicare Providers

1386633543 — DR. ZIA UDDIN KHAN MD
Practice Location Address:

5785 S FORT APACHE RD , SUITE A-100
LAS VEGAS, NV
89148-5659

Practice Phone: 702-822-2273
Practice Fax: 702-734-3278

1255301347 — MARIA C ADOLFO MD
Practice Location Address:

5785 S FORT APACHE RD , STE. 100B
LAS VEGAS, NV
89148-5659

Practice Phone: 702-228-3111
Practice Fax: 702-228-0411

1003904665 — ZK ENTERPRISES, INC
Practice Location Address:

5785 S FORT APACHE RD , SUITE A-100
LAS VEGAS, NV
89148-5659

Practice Phone: 702-822-2273
Practice Fax: 702-734-3278

1134348816 — TIMOTHY M. TOLAN, M.D., INC.
Practice Location Address:

5785 S. FORT APACHE
LAS VEGAS, NV
89148

Practice Phone: 702-735-1400
Practice Fax: 702-688-4193

1801051396 — LISA J HENRY LMSW
Practice Location Address:

5785 GREENSPOINT DR , #915
FORT WORTH, TX
76112-2435

Practice Phone: 469-328-8810
Practice Fax:

1134385305 — NEXT STEP ADDICTION SERVICES
Practice Location Address:

5785 GREENSPOINT DR , #915
FORT WORTH, TX
76112-2435

Practice Phone: 469-328-8810
Practice Fax:

Directions to “FOUNDATION SURGERY AFFILIATE OF FORT WAYNE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.