Carefirst of Fortwayne Inc

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

69000127A Issued in IN

Legal business name

CAREFIRST OF FORTWAYNE INC

Doing business as

Advanced Healthcare

Practice address

718 N Wayne St
Angola, IN 46703-1006

Phone

(260) 624-3093

NPI assigned

Aug 6, 2007

Last updated

Nov 15, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Russell Edward Johnson, RRT

Title

President

Phone

(260) 373-1600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Advanced Healthcare Doing business as

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1306037254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3204 CONGRESSIONAL PKWY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468084417",
            "telephone_number": "260-373-1600",
            "fax_number": "260-373-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 N WAYNE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467031006",
            "telephone_number": "260-624-3093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAREFIRST OF FORTWAYNE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-373-1600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IN",
            "license": "69000127A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "69000127A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cameron Memorial Community Hospital, Inc (Cameron Anesthesiology)
• Cameron Memorial Community Hospital, Inc (Cameron Family Medicine-North)
• Cameron Memorial Community Hospital, Inc.
• Cameron Memorial Community Hospital, Inc.
• Cameron Memorial Community Hospital, Inc.
• Kaitlyn Adele Carlin
• Kyley Jordan Carlin
• Valerie Lynne Case, BS
• CG-Dsa, LLC
• CG-Dsa, LLC

• Oxygen Equipment & Supplies (DME) in Angola, IN
• Providers in Angola, IN by specialty
• Oxygen Equipment & Supplies (DME) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; 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.