NPIMap

Organization Active NPI

Planned Parenthood of Indiana Fort Wayne

  • Non-Surgical Family Planning Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1104175900
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Surgical Family Planning Clinic/CenterTaxonomy code 261QF0050X
License
01041899A Issued in IN
Legal business name
PLANNED PARENTHOOD OF INDIANA FORT WAYNE
Practice address
3914 W. Jefferson Blvd.
Fort Wayne, IN 46804
Phone
(260) 423-1322
Fax
(260) 423-2692
NPI assigned
Sep 7, 2012
Organization subpart
Yes
Parent organization
PLANNED PARENTHOOD OF INDIANA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Authorized official

Name
Ms. Suannah Wilson Overholt, J.D.
Title
Vice President, Finance & Administr
Phone
(317) 637-4166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Surgical Family Planning Clinic/Center 261QF0050X 01041899A IN Primary

Addresses

Primary practice location

3914 W. Jefferson Blvd.
Fort Wayne, IN 46804

Mailing address

200 S. Meridian St.
Suite 400
Indianapolis, IN 46225
Phone (317) 637-4343

Other identifiers 2

IdentifierTypeStateIssuer
100326600MedicaidIN
2002955610MedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Planned Parenthood of Indiana Terre Haute30 organizations share this tax ID, including this one
Part of
Planned Parenthood of Indiana Terre Haute

Other organizations with this tax ID 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1104175900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S. MERIDIAN ST.",
            "address_2": "SUITE 400",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46225",
            "telephone_number": "317-637-4343",
            "fax_number": "317-637-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3914 W. JEFFERSON BLVD.",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-423-1322",
            "fax_number": "260-423-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLANNED PARENTHOOD OF INDIANA FORT WAYNE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLANNED PARENTHOOD OF INDIANA, INC.",
        "enumeration_date": "2012-09-07",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "OVERHOLT",
        "authorized_official_first_name": "SUANNAH",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "VICE PRESIDENT, FINANCE & ADMINISTR",
        "authorized_official_telephone_number": "317-637-4166",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "IN",
            "license": "01041899A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100326600",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2002955610",
            "state": "IN"
        }
    ],
    "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 Sep 7, 2012; 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.