NPIMap

Organization Active NPI

Spine Technology and Rehabilitation PC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fort Wayne, IN
National Provider Identifier
1295905529
Registry record updated Jan 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
SPINE TECHNOLOGY AND REHABILITATION PC
Practice address
3898 New Vision Dr
Suite B
Fort Wayne, IN 46845-1718
Phone
(260) 459-7313
Fax
(260) 436-0628
NPI assigned
Mar 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2011

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

Authorized official

Name
Joseph Fortin, DONPI 1841292612
Title
Physician Owner
Phone
(260) 459-7313

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

3898 New Vision Dr
Suite B
Fort Wayne, IN 46845-1718

Mailing address

3898 New Vision Dr
Suite B
Fort Wayne, IN 46845-1718
Phone (260) 459-7313

National Provider Directory

National Provider Directory
Tax ID family
Spine Technology and Rehabilitation PC2 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.

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": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1295905529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3898 NEW VISION DR",
            "address_2": "SUITE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451718",
            "telephone_number": "260-459-7313",
            "fax_number": "260-436-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3898 NEW VISION DR",
            "address_2": "SUITE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451718",
            "telephone_number": "260-459-7313",
            "fax_number": "260-436-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE TECHNOLOGY AND REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "FORTIN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "260-459-7313",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Jan 11, 2011; 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.