Provider Demographics
NPI:1568795409
Name:CENTER FOR COLON AND RECTAL CARE LLC
Entity Type:Organization
Organization Name:CENTER FOR COLON AND RECTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-672-1719
Mailing Address - Street 1:12012 WOOD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-4515
Mailing Address - Country:US
Mailing Address - Phone:260-672-1719
Mailing Address - Fax:
Practice Address - Street 1:12012 WOOD GLEN DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-4515
Practice Address - Country:US
Practice Address - Phone:260-672-1719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty