IV Hydration Vitamin Therapy LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

IV HYDRATION VITAMIN THERAPY LLC

Practice address

10020 Auburn Park Dr Ste a
Fort Wayne, IN 46825-2389

Phone

(260) 705-7457

NPI assigned

Nov 14, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Fast

Title

Manager

Phone

(765) 730-2130

Specialties & licenses 6

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa D Graham

  • Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1881049161
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1083322473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2624 BARRY KNOLL WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10020 AUBURN PARK DR STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-705-7457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10106 DuPont Circle Dr E",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468251638",
            "country_code": "US",
            "telephone_number": "260-705-7547",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IV HYDRATION VITAMIN THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A",
        "authorized_official_last_name": "FAST",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "765-730-2130"
    },
    "taxonomies": [
        {
            "code": "163WI0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790220101",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1881049161",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1598785149",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edna O Isiorho, RN, APN
• Steven Ison
• Vatche A Israbian, MD
• Christine Marie Itt, PHARMD
• Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC
• Ivy Bridge Therapy LLC
• Ciarra Ivy, RBT
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• J & Y Medical LLC
• Jab Dental Inc.

• Infusion Therapy Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Infusion Therapy Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.