Northeast Indiana Genetics, LLC

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

Legal business name

NORTHEAST INDIANA GENETICS, LLC

Practice address

7230 Engle Rd
Fort Wayne, IN 46804-2209

Phone

(260) 482-3886

Fax

(260) 482-1910

NPI assigned

Jan 27, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Joseph Bader

Title

Office Manager

Phone

(260) 482-3886

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1390780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517356800000",
    "number": "1356764419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7230 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042209",
            "telephone_number": "260-482-3886",
            "fax_number": "260-482-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042209",
            "telephone_number": "260-482-3886",
            "fax_number": "260-482-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDIANA GENETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-27",
        "last_updated": "2018-01-31",
        "status": "A",
        "authorized_official_last_name": "BADER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "260-482-3886",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN MEDICAL LICENSING",
            "identifier": "01022953A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northeast Foot & Ankle Clinic Inc
• Northeast Indiana Ambulatory Surgery Center LLC
• Northeast Indiana Colon Rectal Surgeons PC
• Northeast Indiana Colon Rectal Surgeons, P.C.
• Northeast Indiana Genetic Counseling Center Inc
• Northeast Indiana Orthodontics, LLC
• Northeast Indiana Pediatric Specialists, PC
• Northeast Indiana Urology PC
• Northeast Indiana Urology, P.C.
• Northeast Indiana Urology, PC

• Clinical Genetics (M.D.) Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Genetics (M.D.) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; 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.