MEDICARE: ASSOCIATED SURGEONS AND PHYSICIANS, 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	363L00000X	Nurse Practitioner		IN
2	207R00000X	Internal Medicine Physician		IN

General Provider Information

NPI Number	:	1992097026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED SURGEONS AND PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	2518 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1675
Country	:	US
Telephone Number	:	260-432-4400
Fax Number	:	260-969-6884

Provider Business Practice Location Address
First Line	:	10002 AUBURN PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2389
Country	:	US
Telephone Number	:	260-482-1681
Fax Number	:	260-482-1857

Authorized Official
Title or Position	:	CFO
Name	:	TRISH WARREN
Credential	:
Telephone Number	:	260-432-4400

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	06/13/2016

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