Provider Demographics
NPI:1588653497
Name:FRED TOENGES ORTHOTICS
Entity Type:Organization
Organization Name:FRED TOENGES ORTHOTICS
Other - Org Name:TOENGES ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:WM
Authorized Official - Last Name:TOENGES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:260-483-5219
Mailing Address - Street 1:2417 HOBSON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2917
Mailing Address - Country:US
Mailing Address - Phone:260-483-5219
Mailing Address - Fax:260-484-2291
Practice Address - Street 1:2417 HOBSON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-2917
Practice Address - Country:US
Practice Address - Phone:260-483-5219
Practice Address - Fax:260-484-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0003093352335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0192680001Medicare ID - Type Unspecified