INTERDISCIPLINARY DIAGNOSTIC AND EVALUATION CENTER, INC. (NPI# 1093938102) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1093938102 |
Entity Type | Organization |
Organization Name | INTERDISCIPLINARY DIAGNOSTIC AND EVALUATION CENTER, INC. |
Practice Address |
3030 Lake Ave Suite 7 Fort Wayne IN 46805-5428 |
Practice Telephone | 2604222838 |
Mailing Telephone | 2604222838 |
Enumeration Date | 2007-04-10 |
Last Update Date | 2008-06-17 |
Authorized Official Name | MARILYN NATHAN (CLINICAL DIRECTOR) |
Authorized Official Telephone | 7652849573 |
Authorized Official Credential | PH.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
Street Address |
3030 LAKE AVE SUITE 7 |
City | FORT WAYNE |
State | IN |
Zip Code | 46805-5428 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073507745 | Thomas P Van Den Driessche | Family Medicine | 3030 Lake Ave, Suite32, Fort Wayne, IN 46805-5428 | 2005-09-08 |
1417494170 | Linzie Tuck | Behavioral Analyst | 3030 Lake Ave, Suite 20, Fort Wayne, IN 46805-5428 | 2017-01-19 |
1447587696 | Indiana Endocrine Specialist, LLC | Clinic/Center | 3030 Lake Ave, Suite 17, Fort Wayne, IN 46805-5428 | 2009-11-09 |
1225204613 | Marilyn Arlene Nathan | Psychologist | 3030 Lake Ave, Fort Wayne, IN 46805-5428 | 2008-05-05 |
1538349956 | Thomas P Van Den Driessche | Family Medicine | 3030 Lake Ave, Suite 32, Fort Wayne, IN 46805-5428 | 2007-11-14 |
1417156456 | Nora Marie Stewart | Audiologist-Hearing Aid Fitter | 3030 Lake Ave, Suite 23, Fort Wayne, IN 46805-5428 | 2007-07-11 |
1093916959 | Little Turtle Pediatrics, P.C. | Pediatrics | 3030 Lake Ave, Suite 10, Fort Wayne, IN 46805-5428 | 2007-05-29 |
1780899096 | Michael Joseph Luarde | Dentist | 3030 Lake Ave, Suite 19, Fort Wayne, IN 46805-5428 | 2007-05-11 |
1790801512 | Pediatric & Adult Allergy Asthma & Immunology Specialists, LLC | Allergy & Immunology | 3030 Lake Ave, Suite 27, Fort Wayne, IN 46805-5428 | 2007-03-22 |
1568595999 | Pediatrics Center of Fort Wayne, P.C. | Pediatrics | 3030 Lake Ave, #25a, Fort Wayne, IN 46805-5428 | 2007-03-14 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
Find all providers in zip 46805 |
Taxonomy Code | 261QD1600X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Developmental Disabilities |
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
Notes: [7/1/2003: new] |
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1215105663 | Children's Autism Center, Inc | Clinic/Center | 6208 Constitution Dr Ste A, Fort Wayne, IN 46804-1585 | 2008-02-19 |
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1528674579 | Karen Ashley | Clinic/Center | 2616 French Creek Dr, New Albany, IN 47150-9111 | 2020-09-16 |
1811428501 | Anchored Care Residential Services LLC | Clinic/Center | 1800 N Meridian St Ste 401, Indianapolis, IN 46202-1433 | 2017-03-23 |
1467812370 | Reach Services, Inc. | Clinic/Center | 1400 Hulman St, Terre Haute, IN 47802-2536 | 2016-03-04 |
1114285855 | Bierman Aba Inc. | Clinic/Center | 1025 E 54th St, Indianapolis, IN 46220-3219 | 2012-05-01 |
1295030666 | Lise D Delong | Clinic/Center | 1678 Fry Rd Ste C, Greenwood, IN 46142-1176 | 2011-01-17 |
1881826584 | Z and Z Inc. LLC | Clinic/Center | 13295 Illinois St Ste 106, Carmel, IN 46032-3020 | 2009-08-13 |
1467924324 | Journeys Behavior Learning Center LLC | Clinic/Center | 1316 W Dragoon Trl, Mishawaka, IN 46544-4713 | 2018-12-17 |
1659842490 | South Bend Behavioral Health LLC | Clinic/Center | 701 N Niles Ave, South Bend, IN 46617-1923 | 2018-12-05 |
1669967428 | Embracing Abilities Inc | Clinic/Center | 1182 Scarlet Quarry Cir, Avon, IN 46123-9372 | 2018-06-25 |
1053722637 | Cornerstone Support Services, LLC | Clinic/Center | 6214 Morenci Trl, Suite 100, Indianapolis, IN 46268-2574 | 2014-05-16 |
Find all providers with the same taxonomy |
City | FORT WAYNE |
Zip Code | 46805 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.