Indiana Plastic Surgery Center, PC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

01043388A Issued in IN

Legal business name

INDIANA PLASTIC SURGERY CENTER, PC

Practice address

10020 Dupont Circle CT
Suite 100
Fort Wayne, IN 46825-1620

Phone

(260) 489-0099

Fax

(260) 489-0066

NPI assigned

Jan 22, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Robert N Severinac, M.D.

Title

President

Phone

(260) 489-0099

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1174861454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10020 DUPONT CIRCLE CT",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251620",
            "telephone_number": "260-489-0099",
            "fax_number": "260-489-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10020 DUPONT CIRCLE CT",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251620",
            "telephone_number": "260-489-0099",
            "fax_number": "260-489-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA PLASTIC SURGERY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-22",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "SEVERINAC",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-489-0099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IN",
            "license": "01043388A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200024970",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Indiana Medical Associates, LLC
• Indiana Pathology Consultants, Inc.
• Indiana Pediatric Dental & Anesthesia LLC
• Indiana Physical Therapy Inc
• Indiana Physical Therapy, Inc
• Indiana Professional Psychological Services, P.C.
• Indiana Psychiatric Associates LLC (Indiana TMS)
• Indiana Retina Center LLC (Indiana Retina Center)
• Indiana Surgical Specialists, LLC
• Indiana University (IU Fort Wayne Lafayette Street Family Health Clinic)

• Medical Specialty Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Medical Specialty Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; 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.