Provider Demographics
NPI:1649422668
Name:FT. WAYNE-ALLEN COUNTY DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FT. WAYNE-ALLEN COUNTY DEPARTMENT OF HEALTH
Other - Org Name:ALLEN COUNTY AUDITOR
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-449-7578
Mailing Address - Street 1:200 E BERRY ST.
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2738
Mailing Address - Country:US
Mailing Address - Phone:260-449-7578
Mailing Address - Fax:260-427-1391
Practice Address - Street 1:4813 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-3018
Practice Address - Country:US
Practice Address - Phone:260-449-7578
Practice Address - Fax:260-427-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041980A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200946540AMedicaid
IN100052870CMedicaid