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1497758429

NPI Code Detail

MEDICARE: FORT WAYNE ORTHOPAEDICS LLC

MEDICARE: FORT WAYNE ORTHOPAEDICS 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	207XS0106X	Orthopaedic Hand Surgery Physician	50002482	IN
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	50002482	IN
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	50002482	IN
4	207XX0801X	Orthopaedic Trauma Physician	50002482	IN
5	213E00000X	Podiatrist	50002482	IN
6	213ES0103X	Foot & Ankle Surgery Podiatrist
7	363A00000X	Physician Assistant	50002482A	IN
8	363L00000X	Nurse Practitioner	50002482A	IN
9	363LF0000X	Family Nurse Practitioner
10	207X00000X	Orthopaedic Surgery Physician	50002482A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1497758429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WAYNE ORTHOPAEDICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 2526
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46801-2526
Country	:	US
Telephone Number	:	260-436-8686
Fax Number	:	260-436-8585

Provider Business Practice Location Address
First Line	:	7601 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4133
Country	:	US
Telephone Number	:	260-436-8686
Fax Number	:	260-436-8585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERALD L COOPER
Credential	:	M.D.
Telephone Number	:	260-436-8686

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/19/2015

Similar Medicare Providers

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Practice Location Address:

7601 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4133

Practice Phone: 317-802-2000
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1447495296 — ERIN M. RICHMOND NP
Practice Location Address:

7601 W JEFFERSON BLVD
FORT WAYNE, IN
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1407706187 — BAILEY DANIELLE ANSON PA-C
Practice Location Address:

7601 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4133

Practice Phone: 260-436-8686
Practice Fax:

1013910041 — DR. DOMINICK DETOMMASO D.P.M.
Practice Location Address:

7601 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4133

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Practice Fax: 260-436-8585

1437152469 — STEVEN E FISHER M.D.
Practice Location Address:

7601 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4133

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Practice Fax: 260-436-8585

1780687707 — BENJAMIN MATTHEW HICKS M.D.
Practice Location Address:

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Practice Fax: 260-436-8585

Directions to “FORT WAYNE ORTHOPAEDICS 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.

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