Provider Demographics
NPI:1508069972
Name:INDIANA UNIVERSITY
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY
Other - Org Name:IU FORT WAYNE LAFAYETTE STREET FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PATIENT CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RRT
Authorized Official - Phone:317-278-9059
Mailing Address - Street 1:2700 S LAFAYETTE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806
Mailing Address - Country:US
Mailing Address - Phone:260-481-0400
Mailing Address - Fax:765-496-1227
Practice Address - Street 1:2700 SOUTH LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806
Practice Address - Country:US
Practice Address - Phone:260-744-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURDUE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility