Provider Demographics
NPI: | 1508967266 |
---|---|
Name: | QHG OF FORT WAYNE COMPANY, LLC |
Entity Type: | Organization |
Organization Name: | QHG OF FORT WAYNE COMPANY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBBIE |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | BREWER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 877-892-9813 |
Mailing Address - Street 1: | 7100 COMMERCE WAY |
Mailing Address - Street 2: | SUITE 180 |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-2851 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-465-7000 |
Mailing Address - Fax: | 615-465-3007 |
Practice Address - Street 1: | 315 E COOK RD |
Practice Address - Street 2: | |
Practice Address - City: | FORT WAYNE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46825-3311 |
Practice Address - Country: | US |
Practice Address - Phone: | 260-489-8218 |
Practice Address - Fax: | 260-489-3853 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-26 |
Last Update Date: | 2009-03-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty |