| Fawver Waldo Clinic Llp | |
|
6920 Pointe Inverness Way Suite 250 Fort Wayne IN 46804-7926 | |
| (260) 436-4060 | |
| (260) 436-5713 |
| Full Name | Fawver Waldo Clinic Llp |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 6920 Pointe Inverness Way, Fort Wayne, Indiana |
| Authorized Official Name and Position | Jay D Fawver (MANAGING PARTNER) |
| Authorized Official Contact | 2604364060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fawver Waldo Clinic Llp 6920 Pointe Inverness Way Suite 250 Fort Wayne IN 46804-7926 Ph: (260) 436-4060 | Fawver Waldo Clinic Llp 6920 Pointe Inverness Way Suite 250 Fort Wayne IN 46804-7926 Ph: (260) 436-4060 |
| NPI Number | 1174536346 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174536346 | NPI | - | NPPES |
| DD0871 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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