Melmar LLC

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

01043881A Issued in IN

Legal business name

MELMAR LLC

Practice address

2410 N Glendale Dr
Suite C
Fort Wayne, IN 46804-8908

Phone

(260) 432-7654

Fax

(260) 432-7709

NPI assigned

Jun 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marcus A Jimenez, M.D.NPI 1578655494

Title

Coo

Phone

(260) 432-7654

Specialties & licenses 1

Addresses

Other names 1

• Indiana Vein and Laser Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 2

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

• Marcus A Jimenez, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Fort Wayne, IN
  • NPI 1578655494
  Medicare reassignment Authorized official
• Shawn Dee Brown, CPO

  • Prosthetic/Orthotic Supplier
  • Fort Wayne, IN
  • NPI 1184156101
  NPD (past)

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356544308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 N GLENDALE DR",
            "address_2": "SUITE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468048908",
            "telephone_number": "260-432-7654",
            "fax_number": "260-432-7709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 N GLENDALE DR",
            "address_2": "SUITE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468048908",
            "telephone_number": "260-432-7654",
            "fax_number": "260-432-7709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELMAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "260-432-7654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "01043881A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Vein and Laser Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Mekota
• Amanda S Melcher, PTA
• Marion Melcher, DPT
• Andre G Melendez, M.D.
• Emily Meller
• Leressa Menardy
• Emiliano Mendoza, PT
• Erick Mendoza, PA-C
• Gil F Mendoza, MD
• Linda K Menke, LCSW MSW

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Indiana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.