NPIMap

Organization Active NPI

Holtsclaw Medical Centre, LLC

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1235146812
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02001568A Issued in IN
Legal business name
HOLTSCLAW MEDICAL CENTRE, LLC
Practice address
4666 W Jefferson Blvd
Suite 140
Fort Wayne, IN 46804-6892
Phone
(260) 432-0100
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Lisa Michelle Holtsclaw, DONPI 1619957164
Title
Member
Phone
(260) 432-0100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 02001568A IN Primary

Addresses

Primary practice location

4666 W Jefferson Blvd
Suite 140
Fort Wayne, IN 46804-6892

Mailing address

4666 W Jefferson Blvd
Suite 140
Fort Wayne, IN 46804-6892
Phone (260) 432-0100

National Provider Directory

National Provider Directory

Locations

4666 W Jefferson Blvd
Ste 140
Fort Wayne, IN 46804
Phone (260) 432-0100

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235146812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4666 W JEFFERSON BLVD",
            "address_2": "SUITE 140",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046892",
            "telephone_number": "260-432-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4666 W JEFFERSON BLVD",
            "address_2": "SUITE 140",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046892",
            "telephone_number": "260-432-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLTSCLAW MEDICAL CENTRE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLTSCLAW",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "260-432-0100",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001568A",
            "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 Aug 22, 2020; 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.