Northeast Indiana Pediatric Specialists, PC

Primary specialty

Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X

License

50004150A Issued in IN

Legal business name

NORTHEAST INDIANA PEDIATRIC SPECIALISTS, PC

Practice address

11123 Parkview Plaza Dr
Ste # 102
Fort Wayne, IN 46845-1707

Phone

(260) 483-0688

Fax

(260) 483-0798

NPI assigned

Oct 18, 2007

Last updated

Oct 18, 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

Sheryl L. Anderson

Title

Manager

Phone

(260) 483-0688

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.

• Starr Newman, P.A.

  • Physician Assistant
  • Fort Wayne, IN
  • NPI 1104064286
  NPD (past)

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1629267323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5191",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468955191",
            "telephone_number": "260-483-0688",
            "fax_number": "260-483-0798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11123 PARKVIEW PLAZA DR",
            "address_2": "STE # 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451707",
            "telephone_number": "260-483-0688",
            "fax_number": "260-483-0798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDIANA PEDIATRIC SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "260-483-0688"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "IN",
            "license": "50004150A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northeast Indiana Genetics, LLC
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• Northeast Indiana Urology PC
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• Pediatric Infectious Diseases Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatric Infectious Diseases Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.