Provider Demographics
NPI:1649478744
Name:ALLIED PHYSICIANS INC
Entity type:Organization
Organization Name:ALLIED PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:KUNKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-399-4704
Mailing Address - Street 1:11104 PARKVIEW CIRCLE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1730
Mailing Address - Country:US
Mailing Address - Phone:260-460-3100
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR
Practice Address - Street 2:STE 110
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1730
Practice Address - Country:US
Practice Address - Phone:260-460-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0515955Medicaid
INCC1549OtherRAILROAD MEDICARE
IN100277310Medicaid
IN5506830003Medicare NSC
INCC1549Medicare PIN
148730Medicare PIN
OH0515955Medicaid