Su Salud Clinic PSC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01056928A Issued in IN

Legal business name

SU SALUD CLINIC PSC

Practice address

4101 Diplomat Plaza Ctr
Fort Wayne, IN 46806-4531

Phone

(260) 444-5695

Fax

(260) 444-5665

NPI assigned

Nov 30, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Mario Augusto Gomez, MD

Title

Family Practice/Owner

Phone

(260) 444-5695

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1689941932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 DIPLOMAT PLAZA CTR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468064531",
            "telephone_number": "260-444-5695",
            "fax_number": "260-444-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 DIPLOMAT PLAZA CTR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468064531",
            "telephone_number": "260-444-5695",
            "fax_number": "260-444-5665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SU SALUD CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "AUGUSTO",
        "authorized_official_title_or_position": "FAMILY PRACTICE/OWNER",
        "authorized_official_telephone_number": "260-444-5695",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01056928A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Stumpf
• Amy E Sturgeon, LISW
• Michael Sturges
• Miranda Sturgis
• Alexa Stynchula, DO
• Brian Su, MD
• Stephanie Rose Subart
• Kevin Subler, DPT
• Stephanie Yvonne Sublett, M.D.
• Rakesh K Subramanian, M. D

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.