Provider Demographics
NPI:1528044005
Name:FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY, INC.
Entity Type:Organization
Organization Name:FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-969-7868
Mailing Address - Street 1:PO BOX 15099
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46885-5099
Mailing Address - Country:US
Mailing Address - Phone:260-484-8830
Mailing Address - Fax:260-483-1911
Practice Address - Street 1:516 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2017
Practice Address - Country:US
Practice Address - Phone:260-668-4040
Practice Address - Fax:260-668-3897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-16
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCA4536OtherMEDICARE RR
INCA4536OtherMEDICARE RR