Provider Demographics
NPI:1003031204
Name:DR N W WORDEN PC
Entity Type:Organization
Organization Name:DR N W WORDEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:574-258-5060
Mailing Address - Street 1:2206 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3301
Mailing Address - Country:US
Mailing Address - Phone:574-258-5060
Mailing Address - Fax:574-258-5076
Practice Address - Street 1:2206 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-3301
Practice Address - Country:US
Practice Address - Phone:574-258-5060
Practice Address - Fax:574-258-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000536A213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDP2429OtherRAILROAD MEDICARE
IN200928250AMedicaid
INDP2429OtherRAILROAD MEDICARE
IN200928250AMedicaid
IN167440Medicare PIN