SURGERY CENTER OF FORT WAYNE (NPI# 1780218115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780218115 |
| Entity Type | Organization |
| Organization Name | SURGERY CENTER OF FORT WAYNE |
| Practice Address |
1721 Magnavox Way Fort Wayne IN 46804-1537 |
| Practice Telephone | 3174505441 |
| Mailing Telephone | 3174505441 |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-06-03 |
| Authorized Official Name | MR. BRANDON EHRET (ADMINISTRATOR) |
| Authorized Official Telephone | 3174505441 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
1721 MAGNAVOX WAY |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-1537 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144215153 | Mark A Fisher | Physician Assistant | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2005-09-15 |
| 1750991147 | Coffman Anesthesiology LLC | Anesthesiology | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2020-07-31 |
| 1821606500 | Makayla Lawson | Nurse Practitioner | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2020-07-17 |
| 1689216442 | Karmen Wilson | Registered Nurse | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2019-10-14 |
| 1295207488 | Lacey Michelle Harvey | Physician Assistant | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2018-12-28 |
| 1982061701 | Jonathan Notelle | Registered Nurse | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2016-01-25 |
| 1548696206 | Thomas A. Straub | Physician Assistant | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2013-09-25 |
| 1679909931 | Jason T. Gaisford | Physician Assistant | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2013-09-18 |
| 1861687923 | Daniel Christopher Roth | Physical Medicine & Rehabilitation | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2007-09-12 |
| 1982654828 | Robert Franklin Jackson II | Orthopaedic Surgery | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2006-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538791272 | Parkview Health System, Inc. | Clinic/Center | 8004 Carnegie Blvd, Fort Wayne, IN 46804-5785 | 2020-02-11 |
| 1881871580 | Fort Wayne Ophthalmic Surgical Center, PC | Clinic/Center | 321 E. Wayne Street, Fort Wayne, IN 46802-2713 | 2008-01-24 |
| 1114950292 | Mgfw Surgery Center, LLC | Clinic/Center | 7916 W. Jefferson Blvd., Ste 100, Fort Wayne, IN 46804 | 2006-07-09 |
| 1144275629 | Foundation Surgery Affiliate of Fort Wayne, LLC | Clinic/Center | 8004 Carnegie Blvd., Fort Wayne, IN 46804-5785 | 2006-05-23 |
| 1417936477 | Orthopaedics Northeast PC | Clinic/Center | 11420 Parkview Circle Dr, Fort Wayne, IN 46845-1729 | 2006-01-10 |
| 1063757227 | Parkview Ortho Center, LLC | Clinic/Center | 11420 Parkview Circle Dr, Fort Wayne, IN 46845-1729 | 2012-11-29 |
| 1588991228 | The Eye Surgical Center of Fort Wayne, LLC | Clinic/Center | 321 E Wayne St, Fort Wayne, IN 46802-2713 | 2009-11-17 |
| 1295749117 | Ft Wayne Cardiac Center LLC | Clinic/Center | 7910 W Jefferson Blvd, Ste. 120, Fort Wayne, IN 46804-4159 | 2006-07-28 |
| 1790709376 | Premier Surgery Center LLC | Clinic/Center | 11141 Parkview Plaza Dr, Suite 200, Fort Wayne, IN 46845-1701 | 2006-07-27 |
| 1093746380 | Surgicenter Group LLC | Clinic/Center | 321 E Wayne St, Fort Wayne, IN 46802-2713 | 2006-07-05 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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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.