MEDICARE: ASSOCIATED ANESTHESIOLOGISTS OF FORT WAYNE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	367500000X	Certified Registered Nurse Anesthetist
2	367H00000X	Anesthesiologist Assistant
3	207L00000X	Anesthesiology Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538159140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED ANESTHESIOLOGISTS OF FORT WAYNE PC

Provider Business Mailing Address
First Line	:	PO BOX 843603
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-3603
Country	:	US
Telephone Number	:	972-233-1999
Fax Number	:	972-233-3666

Provider Business Practice Location Address
First Line	:	6435 W JEFFERSON BLVD # 434
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6203
Country	:	US
Telephone Number	:	260-436-7875
Fax Number	:	260-432-9812

Authorized Official
Title or Position	:	NATIONAL CREDENTIALING DIRECTOR
Name	:	TIFFANY ANN JOLLEY
Credential	:
Telephone Number	:	972-715-5000

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	10/21/2024

Similar Medicare Providers

1316981889 — MICHELLE L HUDSON C.R.N.A.
Practice Location Address:

6435 W JEFFERSON BLVD # 434
FORT WAYNE, IN
46804-6203

Practice Phone: 260-436-7875
Practice Fax: 260-432-9812

1740370915 — DR. TAMEEM ALSAMSAM MD
Practice Location Address:

6435 W JEFFERSON BLVD # 434
FORT WAYNE, IN
46804-6203

Practice Phone: 260-436-7875
Practice Fax: 260-432-9812

1235314998 — SAMUEL J. KING II M.D.
Practice Location Address:

6435 W JEFFERSON BLVD # 434
FORT WAYNE, IN
46804-6203

Practice Phone: 260-436-7875
Practice Fax: 260-432-9812

1124359708 — SUMMIT RETINA CONSULTANTS, P.C.
Practice Location Address:

6435 W JEFFERSON BLVD # 203
FORT WAYNE, IN
46804-6203

Practice Phone: 260-515-2778
Practice Fax:

1134446263 — KENNETH ALAN BURCKARDT M.D.
Practice Location Address:

6435 W JEFFERSON BLVD # 434
FORT WAYNE, IN
46804-6203

Practice Phone: 260-436-7875
Practice Fax: 260-432-9812

1407166077 — PROFESSIONAL PSYCHIATRIC SERVICES, LLC
Practice Location Address:

6203 CONSTITUTION DR
FORT WAYNE, IN
46804-1517

Practice Phone: 260-969-9696
Practice Fax: 260-969-7979

Directions to “ASSOCIATED ANESTHESIOLOGISTS OF FORT WAYNE PC ” 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.