NPIMap

Organization Active NPI

Fort Wayne Gi Pathology Services, PC, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Fort Wayne, IN
National Provider Identifier
1821133901
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
50004501A Issued in IN
Legal business name
FORT WAYNE GI PATHOLOGY SERVICES, PC, INC.
Practice address
7950 W Jefferson Blvd
Gi Pathology
Fort Wayne, IN 46804-4140
Phone
(260) 435-7154
Fax
(260) 435-7633
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Max L Daniels
Title
Corporate Manager
Phone
(260) 432-5867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X 50004501A IN Primary

Addresses

Primary practice location

7950 W Jefferson Blvd
Gi Pathology
Fort Wayne, IN 46804-4140

Mailing address

6110 Constitution Dr
Suite 112
Fort Wayne, IN 46804-1556
Phone (260) 432-5867

National Provider Directory

National Provider Directory

Locations

7250 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 435-7554

6110 Constitution Dr
Ste 112
Fort Wayne, IN 46804
Phone (219) 432-5867

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821133901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6110 CONSTITUTION DR",
            "address_2": "SUITE 112",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041556",
            "telephone_number": "260-432-5867",
            "fax_number": "260-436-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 W JEFFERSON BLVD",
            "address_2": "GI PATHOLOGY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-435-7154",
            "fax_number": "260-435-7633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE GI PATHOLOGY SERVICES, PC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "MAX",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CORPORATE MANAGER",
        "authorized_official_telephone_number": "260-432-5867",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "50004501A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • 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.