INTERDISCIPLINARY DIAGNOSTIC AND EVALUATION CENTER, INC.


Address: 3030 Lake Ave, Suite 7, Fort Wayne, IN 46805-5428
Phone: 2604222838

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QD1600X Clinic/Center
Specialization: Developmental Disabilities
Ambulatory Health Care Facilities

Office Location

Street Address 3030 LAKE AVE
SUITE 7
City FORT WAYNE
State IN
Zip Code 46805-5428

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 261QD1600X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Developmental Disabilities

Taxonomy Definition

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]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306141957 Helping Hands Center for Special Needs Clinic/Center 405 W Wayne St, Fort Wayne, IN 46802-2121 2011-01-12
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
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Competitor

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City FORT WAYNE
Zip Code 46805

Improve Information

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Dataset Information

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.

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