NPIMap

Organization Active NPI

Interdisciplinary Diagnostic and Evaluation Center, Inc.

  • Developmental Disabilities Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1093938102
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
INTERDISCIPLINARY DIAGNOSTIC AND EVALUATION CENTER, INC.
Practice address
3030 Lake Ave
Suite 7
Fort Wayne, IN 46805-5428
Phone
(260) 422-2838
NPI assigned
Apr 10, 2007
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Marilyn Nathan, PH.D.
Title
Clinical Director
Phone
(765) 284-9573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X NU Primary

Addresses

Primary practice location

3030 Lake Ave
Suite 7
Fort Wayne, IN 46805-5428

Mailing address

3030 Lake Ave
Suite 7
Fort Wayne, IN 46805-5428
Phone (260) 422-2838

National Provider Directory

National Provider Directory
Tax ID family
Interdisciplinary Diagnostic and Evaluation Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1093938102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE",
            "address_2": "SUITE 7",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-422-2838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE",
            "address_2": "SUITE 7",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-422-2838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERDISCIPLINARY DIAGNOSTIC AND EVALUATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "NATHAN",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "765-284-9573",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.