NPIMap

Organization Active NPI

VA Northern Indiana Health Care System

  • VA Clinic/Center
  • Fort Wayne, IN
National Provider Identifier
1386028330
Registry record updated Jul 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
License
03233198 Issued in OH
Legal business name
VA NORTHERN INDIANA HEALTH CARE SYSTEM
Practice address
2121 Lake Ave
Fort Wayne, IN 46805-5100
Phone
(260) 426-5431
NPI assigned
Jul 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2015

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

Authorized official

Name
Richard Hayes
Title
Credentialing Specialist
Phone
(260) 426-5431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
VA Clinic/Center 261QV0200X 03233198 OH Primary

Addresses

Primary practice location

2121 Lake Ave
Fort Wayne, IN 46805-5100

Mailing address

4374 County Road 233
Clyde, OH 43410-9750
Phone (419) 463-0025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Hospital certification: CCN 15002F

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
VA NORTHERN INDIANA HEALTH CARE SYSTEM-FT WAYNE
Certification status
Active
Provider type (POS)
Hospital
Participating since
Mar 1, 1991
Last certification
Mar 1, 1991
Beds
200
Facility address
2121 Lake Avenue
Fort Wayne, IN 46805

National Provider Directory

National Provider Directory
Tax ID family
Marion Vamc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437177600000",
    "number": "1386028330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4374 COUNTY ROAD 233",
            "city": "CLYDE",
            "state": "OH",
            "postal_code": "434109750",
            "telephone_number": "419-463-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VA NORTHERN INDIANA HEALTH CARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2015-07-18",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "260-426-5431"
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": "OH",
            "license": "03233198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.