Pediatrics Center of Fort Wayne, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

10137509 Issued in IN

Legal business name

PEDIATRICS CENTER OF FORT WAYNE, P.C.

Practice address

3030 Lake Ave
#25A
Fort Wayne, IN 46805-5428

Phone

(260) 422-4096

Fax

(260) 424-2551

NPI assigned

Mar 14, 2007

Last updated

Aug 22, 2020By 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

Mrs. Elizabeth Fedoriw, B.A., M.A.

Title

Office Administrator

Phone

(260) 422-4096

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebecca Marie Blume, PA-C

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1679664379
  NPD (past)

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568595999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE",
            "address_2": "#25A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-422-4096",
            "fax_number": "260-424-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE",
            "address_2": "#25A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-422-4096",
            "fax_number": "260-424-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS CENTER OF FORT WAYNE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FEDORIW",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "260-422-4096",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "B.A., M.A."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "10137509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kari Peeper
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• Erin Elise Peer, NP-C
• Adrienne Michelle Peery, NP

• Pediatrics Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatrics 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.