MEDICARE: FT. WAYNE-ALLEN COUNTY DEPARTMENT OF HEALTH

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	251K00000X	Public Health or Welfare Agency	01041980A	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649422668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FT. WAYNE-ALLEN COUNTY DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	200 E BERRY ST.
Second Line	:	SUITE 360
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2738
Country	:	US
Telephone Number	:	260-449-7578
Fax Number	:	260-427-1391

Provider Business Practice Location Address
First Line	:	4813 NEW HAVEN AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-3018
Country	:	US
Telephone Number	:	260-449-7578
Fax Number	:	260-427-1391

Authorized Official
Title or Position	:	DEPARTMENT ADMINISTRATOR
Name	:	MRS. MINDY WALDRON
Credential	:
Telephone Number	:	260-449-7578

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	08/15/2022

Similar Medicare Providers

1194713644 — MRS. CHERYL LYNN ERICKSON NP
Practice Location Address:

4813 NEW HAVEN AVE
FORT WAYNE, IN
46803-3018

Practice Phone: 260-449-7504
Practice Fax:

1366563165 — DR. DEBORAH ANNE MCMAHAN MD
Practice Location Address:

4813 NEW HAVEN AVE
FORT WAYNE, IN
46803-3018

Practice Phone: 260-449-7670
Practice Fax: 260-427-1391

1316069164 — DR. THOMAS ELDON HAYHURST M.D.
Practice Location Address:

4813 NEW HAVEN AVE
FORT WAYNE, IN
46803-3018

Practice Phone: 260-449-7920
Practice Fax:

1831600311 — MRS. KELLI ROSE ROE NP
Practice Location Address:

4813 NEW HAVEN AVE
FORT WAYNE, IN
46803-3018

Practice Phone: 260-449-7504
Practice Fax:

1508876459 — DR. MARK TU NGUYEN D.D. S.
Practice Location Address:

7630 N BEACH ST , SUITE 130
FORT WORTH, TX
76137-3018

Practice Phone: 817-605-7272
Practice Fax: 817-605-7270

1972717379 — MY HEALTH MY RESOURCES OF TARRANT COUNTY
Practice Location Address:

1136 WILLIAMS RD
FORT WORTH, TX
76120-3018

Practice Phone: 817-569-4396
Practice Fax: 817-569-4517

Directions to “FT. WAYNE-ALLEN COUNTY DEPARTMENT OF HEALTH ” 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.